Digestive Health Archives

Feel Relief From IBS With Probiotics

Constipation as a result of Irritable Bowel Syndrome, or IBS, can be uncomfortable and disconcerting. Although prescription drugs can provide some relief, it can cause unwelcomed side effects. In fact, in nearly 29 percent of clinical studies, medicines prescribed to treat IBS caused considerable side effects, such as diarrhea, abdominal pain and headache.

An EndoMune Advanced customer, who had previously been diagnosed with IBS, was prescribed a medication for chronic constipation. The medication caused her to experience side effects resulting in her feeling discomfort rather than relief. Because of this, she began taking EndoMune Advanced daily and noticed that she no longer relied on her prescription medication to treat her IBS.

Medications prescribed to treat IBS improve constipation by stimulating the intestines to secrete chloride, which, as a result, leads to more fluid in the intestines. These medications treat the symptoms of IBS rather than the underlying problem and disrupt the healthy balance of intestinal bacteria. Probiotics, on the other hand, re-establish the health balance that had been disrupted and corrects the underlying problem that causes the constipation.

Before turning to prescription medication to treat your IBS, try a probiotic supplement, like EndoMune Advanced, and you just might find the relief you seek.

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Ease “Tummy Aches” With Probiotics

Digestive Health, Healthy Aging / By @drHoberman

Surveys have found that 10-20% of children have been diagnosed with Irritable Bowel Syndrome (IBS). Symptoms of abdominal pain, distention, diarrhea and constipation can be very debilitating for the child and distressing for the parents.

A study conducted by Dr. Ruggiero Francavilla published in the Journal of Pediatrics in 2011 evaluated the benefits of probiotics versus a placebo in alleviating IBS symptoms in children.

The team of researchers studied 141 Italian children over the course of eight weeks. The children, whose ages ranged from five to 14, were divided into three groups, two receiving a probiotic supplement and one receiving a placebo. Results from the study concluded that those taking the probiotic had a 50% reduction in IBS symptoms compared to the placebo group.

If your child has been diagnosed with IBS and struggles with ongoing symptoms, you may want to consider a trial of a high quality probiotic like EndoMune Jr.

It is always best to check with your child’s physician before starting a probiotic.

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Celebrate Holiday Gut Health

Digestive Health, Mental Health / By @drHoberman

The holiday season is upon us and that means traveling, eating rich foods and celebrating with family and friends. With all these activities, there is no time to have an unhappy tummy. Taking a daily probiotic can help maintain the normal intestinal activity despite the changes in diet, hectic schedule and travel.

Dependent upon the vacation destination, traveler’s diarrhea can be a problem. Studies have found that probiotics can help enhance normal intestinal immunity and maintain the good bacteria to help in our digestion. In addition, probiotics can lessen the risk of contracting traveler’s diarrhea by 30-40%; therefore, everyone should make it part of their “travel insurance.”

Traveling and visiting family and friends does increase the risk of picking up cold and flu viruses. By taking a daily probiotic, it can lessen the risk of catching these infections, especially for children.

The bottom line is, enjoy the holidays and consider taking a daily dose of EndoMune Advanced. If you have children, give them an EndoMune Jr. It may help to protect their GI and respiratory systems.

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How to get rid of diarrhea

Children’s Health, Digestive Health, Women’s Health / By @drHoberman

Taking probiotics may be helpful in preventing diarrhea, but a review of more than 63 studies by the Cochrane Library suggests that it can help to get rid of diarrhea quicker.

This review of nearly 8,000 patients — including 56 focused on infants and young children — concluded the use of probiotics shortened the course of diarrhea by a day, and reduced the duration of diarrhea lasting more than four days by 59 percent.

Also, probiotics decreased the chances of spreading the diarrhea infection and relieved discomfort.

Lactobacillus acidophilus and Bifidobacterium bifidum — both critical strains of beneficial bacteria contained in EndoMune Advanced Probiotic and EndoMune Junior, –were among the strains of probiotic bacteria used in the studies.

Researchers found no difference between the strains of probiotic bacteria used as all the strains proved to be safe and beneficial to the study participants.

“A striking finding of this review is that most trials reported that probiotics reduced diarrhea,” said lead researcher Stephen Allen of the School of Medicine at Swansea University, UK, according to a press release. “The beneficial effect was consistent and significant across many different types of trials.”

Be wary of standard diarrhea treatments

Unfortunately, three of the more popular ways to treat diarrhea — taking an antibiotic or an over-the-counter medication or eating specific foods — may not be as safe or reliable and create more health complications you’ll want to avoid, especially if your child is at risk.

For example, some health experts advise taking antibiotics, but only if bacteria or parasites trigger diarrhea. Yet, antibiotics can cause great harm not only by disrupting the healthy balance of bacteria in your gut but by promoting the spread of antibiotic-resistant superbugs like C. diff infections.

Also, taking an over-the-counter drug like loperamide (Imodium) or bismuth-subsalicylate (Pepto Bismol) only treats diarrhea, but not the underlying cause of the problem. Plus, you should be very careful if your child has the flu or chickenpox that you don’t treat him/her with medicines that contain bismuth-subsalicylate due to their link to Reye syndrome, a rare but very serious disease.

Plus, the verdict is very much mixed about the value of following the BRAT diet (bananas, rice, applesauce and toast), particularly for children because it doesn’t contain enough nutrients to help their guts recover from diarrhea.

However, taking a probiotic is one of most effective ways, not only to shorten the duration of diarrhea, but to give your body a healthy boost to its natural defenses to prevent it altogether.

The real trick about probiotics: There’s a huge difference between taking a probiotic containing single or multiple strains of beneficial bacteria.

A growing number of studies have shown taking a multi-species probiotic like EndoMune — containing 10 strains beneficial bacteria plus a prebiotic– are effective in treating a host problems in addition to diarrhea, including IBS, respiratory tract infections and immune functioning. More information about traveler’s diarrhea can be found here.

How to get rid of diarrhea Read More »

Not-So-Sweet News For Your Gut

Diet, Digestive Health / By @drHoberman

Multiple studies have been performed on the impact that fructose and artificial sweetners have upon the body. Now new research supports that these items, with the addition of sugary alcohols may contribute to metabolic disorders and obesity by triggering a “Western” gut microbiome. The microbiome occurs as a result of decreased diversity in the intestinal tract.

The impact of this microbiome can range from short-term to long-term, depending on your rate of consumption. To combat its negative impacts and promote a healthily diverse digestive bacteria environment, try a product like EndoMune which delivers both potency and variety.

Check out the full article and learn more about how the impact the “Western” gut microbiome is having upon recent community health.

Not-So-Sweet News For Your Gut Read More »

Bloating: Can We Talk About Gas?

Digestive Health, Probiotics / By @drHoberman

Bloating (Intestinal gas) is a very common problem in the general population and is a frequent reason why people seek medical attention. Passage of intestinal gas is viewed differently depending your age and gender.

Kids make lots of jokes and take pride in telling someone to “pull my finger.” Boys grow up to be men who believe passing flatus is not rude or embarrassing and like to use phrases like “whoever smelt it dealt it” or “whoever denied it supplied it.”

Females would like to deny that intestinal gas exists and will try to hold it to avoid any embarrassment. This practice can certainly lead to increased intestinal symptoms of bloating, distention, and discomfort.

One of the most common symptoms leading individuals to seek gastrointestinal evaluation is “gas.” They are convinced that excess gas is the cause of their abdominal bloating and distention. In addition, they believe that the need to belch and expel flatus is also due to an excess production of gas.

There have been many studies evaluating the above mentioned symptoms and results are rather surprising.

BELCHING

Belching is due to swallowing excess air. It is not due to increased intestinal or gastric production.

We all swallow some air when we eat or drink especially carbonated beverages. But people who complain of needing to belch frequently usually have developed an air-swallowing habit. This usually occurs for one of two reasons:

Sometimes people swallow excess air to ease symptoms due to heartburn or ulcers. Easing these symptoms with acid suppressive medications may lessen the desire to swallow air.
The other reason for chronic belching is due to an unconscious way of dealing with stress or anxiety. For these individuals, making them aware of their excess air swallowing can sometimes be helpful.

BLOATING AND DISTENTION

When people experience the discomfort of abdominal bloating and distention, they believe it is due to excess gas production in the intestines.

Studies have determined that people who have symptoms of bloating have no more intestinal gas than normal people¹. The cause of the symptoms has been attributed to “visceral hypersensitivity.”

Visceral hypersensitivity is a term used to describe the heightened level of intestinal discomfort that individuals experience due to normal intestinal activity.

Research studies have found that when air is instilled into the intestines of individuals with visceral hypersensitivity, they experience symptoms of bloating and distention while the normal group notices no discomfort.²

Visceral hypersensitivity has been thought to be part of the syndrome of Irritable Bowel Syndrome(IBS). Historically, this syndrome has been attributed to psychological disorders. However, recent observations have noted that up to 30% of individuals who experience an episode of infectious diarrhea develop post infectious IBS symptoms³. One of the most prominent symptoms of IBS is bloating.

The current thinking is that an intestinal infection disrupts the healthy intestinal bacterial flora resulting in an immune response that leads to chronic low-grade inflammation. The inflammation then causes visceral hypersensitivity.

Recent studies using probiotics to re-establish the normal intestinal bacterial flora have been successful in down regulating the inflammation and easing the symptoms of bloating.^4,5

FLATULENCE

Here are some interesting facts you can share with your friends, about flatulence:

Passage of gas or flatus is normal. Generally, healthy people pass 8-25 ounces daily. Frequency is 10-20 passages/day.

Gas is produced by intestinal bacteria primarily located in the colon.

The amount gas produced is determined by three factors:

The amount and type of carbohydrates consumed
The amount and types of intestinal bacteria present
The ability of the small intestines to digest and absorb the carbohydrates

Two common causes of excess flatulence are:

poor digestion of the sugar lactose in dairy products;
limited absorption of fructose which is a sugar found in soft drinks and certain fruits like apples and bananas.

Some vegetables have starches that are only partially absorbed. The nonabsorbed starches pass into the colon and contribute to excess flatus production. Beans, brussel sprouts, carrots, onions and celery are the major offenders.

The carbohydrates in bread and pasta can be a problem for some people. Recently, there has been a lot written about “gluten sensitivity.” Avoiding the grains of wheat, barley, and rye can help some people lessen the production of excess flatus.

Colonic bacteria normally generate intestinal gas through fermentation of the carbohydrates that escaped absorption in the small intestines. An imbalance in the gut bacterial flora may result in excessive gas formation. Some bacterial groups are more prone to gas production than others. Hence, improving the bacterial balance with a probiotic may improve gas-related symptoms.⁸

Take Home Message

If you are experiencing symptoms of bloating, distention, or increased flatus, consider taking a high quality probiotic like EndoMune.

In addition, you may want to modify your diet by avoiding foods that contribute to flatulence. It is always wise to check with your doctor if your symptoms persist.

Eat healthy, exercise and live well!!!

Best Wishes,

Dr. Hoberman

Foods that may cause gas include:*

Beans
Vegetables, such as broccoli, cabbage, brussels sprouts, onions, artichokes, and asparagus
Fruits, such as pears, apples, bananas and peaches
Whole grains, such as whole wheat and bran
Soft drinks and fruit drinks
Milk and milk products, such as cheese and ice cream, and packaged foods prepared with lactose, such as bread, cereal, and salad dressing
Foods containing sorbitol, such as dietetic foods and sugar-free candies and gums

References

*National Digestive Diseases Information Clearinghouse
Gas in the Digestive Tract

http://digestive.niddk.nih.gov/ddiseases/pubs/gas/

1) An understanding of excessive intestinal gas.
Suarez FL, Levitt MD.Curr Gastroenterol Rep. 2000 Oct;2(5):413-9. Review.

2) J Gastroenterol Hepatol. 2011 Apr;26 Suppl 3:119-21. doi: 10.1111/j.1440-1746.2011.06640.x.Visceral hypersensitivity in irritable bowel syndrome.
Kanazawa M, Hongo M, Fukudo S

3) Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak.Zanini B, Ricci C, Bandera F, Caselani F, Magni A, Laronga AM, Lanzini A; San Felice del Benaco Study Investigators.Am J Gastroenterol. 2012 Jun;107(6):891-9. doi: 10.1038/ajg.2012.102. Epub 2012 Apr 24.

4) The putative role of the intestinal microbiota in the irritable bowel syndrome.
Collins SM, Denou E, Verdu EF, Bercik P.Dig Liver Dis. 2009 Dec;41(12):850-3

5) Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study.
Ringel-Kulka T, Palsson OS, Maier D, Carroll I, Galanko JA, Leyer G, Ringel Y.
J Clin Gastroenterol. 2011 Jul;45(6):518-25.

6) Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity.Carroccio A, Mansueto P, Iacono G, Soresi M, D’Alcamo A, Cavataio F, Brusca I, Florena AM, Ambrosiano G, Seidita A, Pirrone G, Rini GB.Am J Gastroenterol. 2012 Jul 24. doi: 10.1038/ajg.2012.236.

7) Review article: the treatment of functional abdominal bloating and distension.Schmulson M, Chang L.Aliment Pharmacol Ther. 2011 May;33(10):1071-86. doi: 10.1111/j.1365-2036.2011.04637.x. Epub 2011 Mar 29. Review.

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Deficiencies in Regulating C. Diff

Digestive Health, Disease / By @drHoberman

C. diff is a bacterial infection that spreads via fecal contamination and takes root once bad bacteria take over the intestinal bacteria balance. This infection creates a number of increasingly serious symptoms like diarrhea, weakness, cramping, and vomiting. It is a 100% preventable condition, but often times, a one-time C diff infection leads to long-term complications, health risks, or death.

Few hospitals and caregiver centers take the necessary action to prevent C. diff outbreaks. The negligence occurs primarily due to budgetary restrictions. However, the implications are dire. Every year thousands of patients lose their lives to C. diff infections, which invade their digestive system, spreading spores taking over, and working against good and bacteria. Antibiotics further the spread, preliminarily killing off the good bacteria needed to combat the digestive tract infection.

Take a probiotic like EndoMune Advanced Probiotic when taking a antibiotic may help prepare your gut to combat serious infections like C. diff. The risk of approaching these infections with too light an attitude is dire. In the article linked below, you’ll learn about the ways C. diff has been spreading in hospitals and the basic steps that can be taken to prevent future infection incidents.

Article

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What Came First – The Chicken or The Infection

Digestive Health, Women’s Health / By @drHoberman

8 million – that’s the number of women currently at risk for difficult-to-treat bladder infections brought on by superbugs, transmitted to humans through E.coli.

But what makes these intestinal superbugs so super?

According to a recent report by the ABC News Medical Blog, superbugs are resistant to antibiotics. This can lead to a bladder infection that many bladder infection sufferers say just won’t go away.

The reason why?

“[Chickens] in many cases, are getting drugs from the time that they were in an egg all the way up to the time they are slaughtered….”

That means are gastrointestinal bacteria chickens transmit post-slaughter has already survived a lifetime of antibiotic treatment before it gets to a human host.

This could have implications for your own digestive health, particularly if you are a woman. Read the full blog here and see what doctors are doing to identify the full extent of intestinal superbugs’ digestive effects.

What Came First – The Chicken or The Infection Read More »

More And More Research Affirms The Benefits Of Healthy Gut Bacteria

Digestive Health, Drug interactions, Healthy Aging / By @drHoberman

Dear EndoMune subscribers,

This month’s newsletter looks at some of the recent research on the positive effects healthy bacteria can have on the digestive system.

When I went into medicine, we spent a long time studying how bacteria caused serious infectious diseases. We learned about the importance of antibiotics and when to use them.

We never had a lecture on how certain bacteria (microflora) have co-evolved with us and how they help maintain our health.

No one really knew much about these healthy bacteria. But it turns out that they are essential for human life. We need them in our gut to digest food, synthesize certain vitamins and form a barricade against disease-causing bacteria.

But what do they look like in healthy people, and how much do they vary from person to person?

“Studies have found that the healthy bacteria can inhibit intestinal immune system from producing immune reactions against food protein lessening the risk of asthma, eczema and other allergies.”

Human Microbiome Project

The National Institute of Medicine launched the Human Microbiome Project¹ (HMP) in 2008. It’s a five-year program to better understand how the bacterial communities (microbiome) that live on and in the human body protect our health.

The HMP involves 200 scientists at 80 institutions. Using the latest genetic techniques, they collect samples of bacterial genetic material from 242 healthy people.

The samples have been collected from five areas of the body: the digestive tract, the mouth, the skin, the nose and the vagina.

The projects reveal some of the ways in which invisible or microscopic bacteria shape our lives from birth to death. The ultimate goal is to test whether changes in the human microbiome are associated with human health or disease.

Benefits of a Healthy Microbiome

For example, researchers² at Baylor College of Medicine have found that the vaginal bacterial flora or microbiomes change during pregnancy. Particular species, like Lactobacillus johnsonii, become dominant. This bacteria is usually found in the human intestinal tract where it produces enzymes that promote digestion of milk and substances that destroy harmful bacteria.

These findings have implications for the newborn. Before birth, the infant is in a sterile environment. The initial exposure to the world of bacteria is during the passage through the birth canal. It has been speculated that the baby will ingest some of the Lactobacillus johnsonii which will aid in digesting breast milk.

Babies born by Caesarean section start out with different microbiomes, but it is not yet known whether their microbiomes remain different after they mature.

During infancy, the baby’s intestinal microbiome expands and is impacted by breastfeeding. A study of 16 lactating women³ found that human breast milk had up to 600 bacterial species and resistant starches. Breast milk helps to promote the healthy intestinal bacteria which aid in digestion, immune function and protection from harmful bacteria.

Studies have found that the healthy bacteria can inhibit intestinal immune systems from producing immune reactions against food protein lessening the risk of asthma, eczema and other allergies.

Future Research Projects

In addition to the above studies, the HMP is doing research on the how the skin microbiome may play a role in skin disorders like psoriasis and eczema.

Other research projects are evaluating the intestinal microbiome in obese versus normal weight individuals. Previous studies have found that there is a difference in the bacterial flora in obese and thin animals and humans. Hopefully, the flora can be manipulated to lessen obesity and the associated disorders of diabetes, hypertension and heart disease.

The point of this newsletter is that the scientific community now recognizes the importance of maintaining a healthy microbiome. The concern is that antibiotics can upset the healthy microbiome and can contribute to chronic disorders like Crohn’s disease, ulcerative colitis and allergies.

Take Home Message

Consider taking a high quality probiotic like EndoMune to maintain a healthy microbiome balance.

Remember, EndoMune contains 10 strains of bacteria, and it is the only probiotic on the market developed by a board certified gastroenterologist.

Eat healthy, exercise and live well!!!
Best Wishes,
Dr. Hoberman

1) Structure, function and diversity of the healthy human microbiome. Human Microbiome Project Consortium.Nature. 2012 Jun 13;486(7402):207-14. doi: 10.1038/nature11234.

2) A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. Aagaard K, Riehle K, Ma J, Segata N, Mistretta TA, Coarfa C, Raza S, Rosenbaum S, Van den Veyver I, Milosavljevic A, Gevers D, Huttenhower C, Petrosino J, Versalovic J. PLoS One. 2012;7(6):e36466. Epub 2012 Jun 13.

3) Characterization of the diversity and temporal stability of bacterial communities in human milk.Hunt KM, Foster JA, Forney LJ, Schütte UM, Beck DL, Abdo Z, Fox LK, Williams JE, McGuire MK, McGuire MA.PLoS One. 2011;6(6):e21313. Epub 2011 Jun 17.

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How To Avoid Traveler’s Diarrhea

Diet, Digestive Health, Disease / By @drHoberman

Dear EndoMune subscribers,

It is summertime and that often means going on a vacation. This newsletter will give you some tips on how to avoid a common gastrointestinal illness while traveling.

During the peak travel seasons, we are bombarded by the Internet and television with all kinds of travel offers. Some trips are just a state or two away, but some journeys extend out of the United States to less developed countries.

This month’s newsletter is on traveler’s diarrhea (TD), a common problem encountered by vacationers visiting Latin America, the Middle East, India and South Asia.

I want to begin with a case report.

Case report

Recently back from her honeymoon at a Playa del Carmen resort in Mexico, Lisa visited her physician complaining of crampy abdominal pain, low-grade fever and diarrhea.

The first 4 days of the trip were terrific. The beaches and activities were wonderful and so was the food. In addition to the fresh fruits and seafood, Lisa particularly enjoyed the salad bar.

Unfortunately, on the fifth day she woke experiencing abdominal cramps and then diarrhea. What a way to end the honeymoon!!

Was there anything that Lisa could have done to prevent developing TD? (See answer at end of this month’s newsletter).

Overview

Diarrhea is the most common medical complaint for Americans visiting developing countries. It is estimated that for Americans traveling internationally, 9.5 to 15.9 million will experience TD. Most episodes last 3-4 days without therapy, but some infections can cause severe diarrhea and dehydration requiring hospitalization, IV fluids and antibiotics.

TD is due to consuming food or water that has been contaminated with fecal matter resulting from poor personal sanitary and public health conditions.

The organisms that cause the diarrhea are bacteria, viruses and parasites. Bacteria like E. coli, Shigella, Salmonella and Campylobacter account for 80% of the episodes of TD. The type of bacterial pathogen depends on the region travelled.

In the medical journal, Current Gastroenterology Report, an article entitled Advances in the Treatment of Traveler’s Diarrhea¹ discusses recent recommendations on how to prevent and treat TD.

Prevention

Diet: Food and water are the most common sources of infection. Reduce your risk of TD by ordering all of your foods well-cooked. Avoid raw vegetables and the skin of unpeeled fruits. Tap water and ice also present a high risk. That includes ice in sodas. The general recommendation to avoid TD is to “boil it, cook it, peel it, or forget it”. Even if it smells and looks great…don’t eat food from street vendors!!

Medications

Antibiotics can prevent TD, but it is not generally recommended to prescribe antibiotics as a prophylaxis due to the potential for adverse drug reactions and the development of drug resistant organisms.
Bismuth subsalicylate (Pepto Bismol) provides a protection rate of 60% against TD when two tablets are taken four times daily. It does cause the tongue and stool to turn black and can induce ringing in the ears.
Probiotic clinical trials using a probiotic or a placebo to prevent TD found that 85% of episodes were prevented by probiotics. The dosage of probiotic bacteria given and the type of organisms varied. The analysis found that probiotics containing Lactobacillus and Bifidobacteria strains were effective and so was the yeast, Saccharomyces boulardii. However, at this point it is still difficult to generalize that all probiotics are effective since the amount and strains of probiotic bacteria utilized varied in the different trials.

Treatment

Fluids: Fluids and electrolytes are major concerns during an episode of TD. Drinking fluids like water and rehydration packets are very important, as is eating salty soups and saltine crackers.

Antimotility Agents: Bismuth subsalicylate (Pepto Bismol) and loperimide (Imodium) taken at the onset of diarrhea can lessen the severity and duration of the episode. They do not cure the infection, and they often are taken in combination with an antibiotic.

Antibiotics: Based on established guidelines, antibiotics are generally recommended if there are 3 or more loose stools in eight hours. Fever and blood in stools are other symptoms indicating the need for antibiotics. Most physicians are comfortable prescribing an antibiotic for their patients to have in case they do develop TD.

The most commonly prescribed antibiotic is a quinolone like Cipro. However, there are regions like Thailand where the bacteria are resistant to Cipro, and azithromycin (Zithromax) is recommended.

Probiotics: Probiotic organisms may help in preventing and treating TD in a number of ways.

They produce antibacterial substances that kill invading pathogens.
They adhere to the intestinal lining cells and act as a shield against invading harmful bacteria.
They stimulate the immune system to produce a response against the pathogens.
Recommendations To Prevent TD:

1) Start taking a good probiotic like EndoMune on a daily basis. Begin at least 2-3 days before starting the trip. When traveling, EndoMune will do fine at room temperature. It is best not to store probiotics at temperatures greater than 85 degrees for prolonged periods.

2) Buy a bottle of Pepto Bismol and a box of Imodium to bring with you just in case you develop TD.

3) Check with your physician about getting a prescription for the appropriate antibiotic for TD.

Final Comments

I hope your travels are safe, joyful and healthy. I think Lisa would have been able to enjoy her entire honeymoon if she had avoided the salad bar and the skin of unpeeled fruits, and if she had taken a daily dose of EndoMune.

Eat healthy, exercise and live well!!!
Best Wishes,
Dr. Hoberman

1) Advances in the treatment of travelers’ diarrhea. Paredes-Paredes M, Flores-Figueroa J, Dupont HL. Curr Gastroenterol Rep. 2011 Oct;13(5):402-7. Review.

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