Usually the chat about probiotics comes up pretty often. A lot of people are aware of probiotics, but aren't always clear on exactly what probiotics are or what they do. I like to explain what probiotics are and how they can help the health of the individual. Quite a few people know about probiotics from yoghurt or from an ad they saw on TV. However, very few of my patients really know how probiotics can help their specific health concern. This is a great opportunity to learn and take charge of their health and make informed decisions. So let me take this opportunity to try and explain what probiotics are and how they work.

What are probiotics?
Probiotics are small bacteria that are used to increase and or replace the good bacteria already present in the body. They promote a healthy digestive tract and support defense mechanisms. 
There are over 500 different strains of bacteria that live in your digestive tract. It is believed that there are 10X more bacteria in your body then there are normal cells. They combine to weigh roughly 1 kg. The genes from these organisms may be as much as 150 times larger than the total human gene content. That's a lot of bacteria!!
The 4 most dominant classes of bacteria are: Bacteroidetes, Firmicutes, Proteobacteria,and Actinobacteria.

There are many many different strains of probiotics for sale out there, each with a claim as to why that strain is the best (that is a whole different topic that should be discussed with your healthcare provider). It is believed that different strains of probiotics have different functions in the body. 

How do probiotics work?
Probiotics have multiple functions in the body such as:

• Barrier of protection - by forming a physical barrier and lining the cells of your digestive tract. This keeps the food from irritating the digestive lining.
• Produce Short Chain Fatty Acids (SCFA's) - promotes growth and differentiation of intestinal cells leading to decreased risk of Colon Cancer and Intestinal Hyperpermeability (aka Leaky gut)
• Increase immune function - by modulating Th1 and Th2 immune responses
• Breaking down food to get more nutrients out of it - probiotics begin digestion of food
• Minimize fermentation in the digestive tract.
• Vitamin K2 production - Vitamin K2 can't be stored in the body so consistent formation of vitamin K2 is crucial to prevent bleeding disorders.

When can I use probiotics?
Probiotics can be useful in many scenarios, here are the most common situations:

• Post-Antibiotic treatment
• Digestive health
• Allergies
• Skin conditions
• Pregnancy
• Urinary tract infections
• Inflammatory conditions

Thats the simple explanation of what probiotics are and how they work. Before picking any probiotics, consult with your healthcare provider to find the best strains for you and your health needs. 

Updated May 31 2015

I was talking to a patient last week about her new years resolution to get healthy.  She mentioned to me that she was interested in doing a detox, like the one she saw on that popular Dr show. I said "ok, no problem, but my detox plan is different than his though. My plan is longer than just a few days." She paused briefly and looked a bit puzzled. I asked "what's the matter?" She said, "wait a sec, what exactly is a detox?" I said "that's a great question...allow me to explain..." This is what I told her:

Detoxification is any process of decreasing the negative impact of xenobiotics (external foreign toxic molecules) on bodily functions. It includes biotransformation of endogenous (within the body) and exogenous (outside the body) molecules into excretable metabolites and or waste products.

There are SIX main pathways of elimination:

1. Skin: sweating promotes removal of soluble toxins
2. Breath: increased breathing helps eliminate water soluble toxins
3. Intestines: all fat soluble toxins leave the liver and are excreted via fecal matter
4. Kidney: all water soluble toxins leave the liver and are excreted via the urine
5. Lymphatics: removes wastes from tissues and is responsible for immune system function.
   
6. Liver: primary organ of detoxification. 

How the Liver detoxifies
The Liver is the primary organ of detoxification. Detoxification occurs in the liver through 3 major pathways: Phase I, Phase II and Phase III. 

• Phase I breaks down fat, glucose, carbohydrates, proteins and toxins to intermediate substances. At this point, these intermediate substances are actually MORE toxic to the body and MUST enter Phase II for proper breakdown. Phase I is "non inducible". This means that for the majority of people, Phase I breakdown occurs non stop in the body, it is not inducible or controlled based on the amount of nutrients it has to use in the breakdown.
• Phase II - the broken down products are converted to fat soluble and water soluble products. These products are now less toxic and able to leave the body through bowel movements (fat soluble) and/or urination (water soluble). Phase II is "inducible". This means that Phase II can be increased or enhanced to help with further breakdown of toxic products. This is why liver health is such a large part of the focus of most detox plans.
• Phase III, the elimination of the products. This step is usually the one that most people forget about. Elimination is done via the 6 pathways mentioned earlier. However, the most important at this stage are the kidneys and intestines. If these organs systems aren't eliminating properly, then you will have an accumulation of waste products. 

• This is why its important to focus on all 6 pathways when you are trying to do a "detox" program. 

After discussing this with my patient, we then setup a specific plan tailored for her to optimize her detox plan and achieve her results.
Always consult with your healthcare provider to have the proper guidance to complete your "detox". 

Updated Oct 2016:
This link is a 15min video that summarizes even more about B12 and B12 deficiency.

I've had quite a few patients ask me, "so what's the difference between all the different types of B12 and why does the cost vary so much, and why should i care?" Ive also had just as many patients tell me that they didn't know that there were different forms of B12. So I put this together to give everyone an idea of the functions of B12 and the differences between the 3 forms of B12. 

B12 Functions
B12 (cobalamin) is one of the many water soluble vitamins that your body needs for good health. B12 is needed to promote digestion; nervous system health; fatty acid metabolism, protein metabolism and folic acid metabolism as well as many enzyme reactions in the body. 

"How can I know that Im low or deficient?"
It is indicated in pernicious and macrocytic anemia. People with low stomach acid will likely absorb less because stomach acid and other factors aid in B12 absorption. It can also manifest in fatigue, cardiac problems, neurological disorders (memory loss, sensation changes, confusion, depression), orthostatic hypotension (feeling dizzy when you stand up quickly), and decreased immune function. It may also affect melatonin production leading to sleep issues. It is also indicated in people taking the oral contraceptive pill. The dosage and method of B12 administration should be discussed with your Naturopath or MD prior to starting the supplement.

Some people have genetic defects that cause them to not convert B12 into the active format effectively. This can be evaluated by genetic testing.

Testing your B12
Serum B12 (blood test) is the most common way to have your B12 levels evaluated. Since B12 is involved in so many processes in the body, I like to see the levels in the mid-high range on the blood test. 

Food sources
According to the Dieticians of Canada, the majority of B12 in your diet comes from meat sources. Therefore people who don't consume meat should consider B12 supplementation. There are currently mixed reviews about algae and its use as a B12 source in the diet. 

So now that we know what B12 does and we know its food sources, "what's the difference between all the different B12 forms?"
There are 3 main forms: Cyano, Methyl, and Hydroxy.

Cyanocobalamin
Is the synthetic form of cobalamin used in many supplements. It's popular because of its low cost and stability. It's usually found only in trace amounts in the body. Cyanocobalamin must be converted to the methylcobalamin form in order to become active in the body. Therefore it has no real function in the body other than to be broken down into an active form. When cyanocobalamin is metabolized, it dissociates leaving the cobalamin (B12) and a cyanide ion. Cyanide is a poison to humans. Due to the cyanide portion of this form of B12, it is contraindicated in smokers and people with kidney problems. It as also been mentioned to be avoided in children with autism (still being debated).

Methylcobalamin
This is the coenzyme form of B12 that is used in the metabolism of all the processes mentioned earlier. This form does not require conversion in the body and is therefore more direct in its actions as a supplement. The main difference here is that the methyl form of B12 costs more. However, now the cost difference between cyano and methyl is not so large. 

Hydroxycobalamin
Is another form of B12 that is very similar to methylcobalamin. These two forms of B12 have shown very similar methods of action, absorption efficiency and effectiveness. The difference here is that Hydroxycobalamin lasts longer in your body. It is not put into the more bioactive form of Methyl right away so your body doesn't use it all up at once. 

The debate will continue on whether to choose cyano or methyl or hydroxy. For my patients, I will always choose methyl or hydroxy forms. For me, there is no point in trying to save money in choosing cyano if I don't absolutely need to. I suppose if something happens to the world's supply of methyl and hydroxy, making them extinct, then yes, I would use cyano. However, until that day comes, I really don't see the need to do so. As for the cyanide safety debate, rather than take a chance with my patients, I would rather just go with the form that is known to not have any concerns with cyanide. It just makes sense to not take the chance with your health. As of now the research claims there is no significant risk in choosing the cyano form, but we used to say the same things about plastics (phthalates, BPA), lead paint, leaded gas, asbestos, hand washing before surgery, and the use of cocaine in coca cola.
So for the minimal difference in cost and the less risk of harm, I would go with methyl or hydroxy, it's more bioavailable and is the more natural form. 

This image is the classic "Vitruvian Man" by Leonardo DaVinci. To me, this image represents the human body and its ideal proportions, health and balance. Back when I started naturopathic med school, if you were to ask me what my definition of healing was, I would likely have gone with something very science textbook-esque. It may have read something like “healing is the restoration of damaged tissue to normal function.” Or maybe even “healing is the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area.” However, now, my understanding of  healing is more a form of evolution; evolving, changing, and always dynamic. Tracking this evolution is what has helped with my understanding of healing. 

As you can likely tell, I am a science major that is used to specific definitions and sets of regulated guidelines with very little room for interpretation. I’m used to things being defined clearly, constant. What I have come to realize is that “the only constant is change”. It has been attending the Canadian College of Naturopathic Medicine, listening to class presentations and doing the class readings that have helped me to realize that there is much more to the nature of healing than I had originally thought. The room for interpretation is what helps to give my understanding of healing its ability to evolve.

It is in these four short years since starting in the ND program that I learnt that there is more to healing than textbooks would have you think. It involves more than just the physical aspects of healing, as this does not encompass the whole person. You have to remember that people are more than just the sum of their parts. It is this mentality that has helped me to realize that you need to look at all facets of healing. 

Healing can encompass the physical, mental, and spiritual path in which individuals need to accomplish their healing goal. As a future practitioner, I need to recognize that everyone is different and as such, I need to tailor my approach accordingly. The evolution of methods in which to treat follows directly with this ever evolving form of healing.

To me, healing needs three key things in order to occur; First, you need an injury. The initial injury or inflammation, be it physical, mental or spiritual, causes this need to heal and is the first step in the process. In order to heal, we need to deviate from our normal health state, otherwise there would be no reason to heal. Secondly you need to have regeneration. The proliferation and regeneration portion of healing can then use various healing methods to encourage the process. The approach taken here is very subjective, appealing to each person’s body, need and desire to heal. The individual approach to healing allows you to grow as an individual whilst healing. Lastly, we need to mature, to integrate our healing into our being to be finally healed. I feel as though this could be the most difficult of the three steps. Difficult in the sense that I think it would be hard to know exactly when you’ve entered this final step. As we heal, our perception of the line between illness and health tends to return. However, knowing exactly when we transition into this phase is tough to discern. We have to listen to our bodies so that they can tell us that we have matured. The pace of this step is what differs us all.