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If I Have Celiac Do I Need to Take Probiotics?

Dr. Cynthia Rudert, Celiac Disease and Gluten Intolerance expert, answers your questions on celiac:

If I have celiac do I need to take probiotics? PROBIOTICS PRO = for; BIO=life (the definition of probiotic)

Dr. Rudert answers:

Generally I recommend probiotics to most of my celiac patients. With few exceptions they are usually well tolerated and help patients that have continued gas and bloating. These ongoing symptoms may be due to SIBO (small intestinal bacterial overgrowth). Probiotics provide "good bacteria" which often have been depleted. Another source of good bacteria can be found in yogurts and other fermented products. Continued symptoms in patients with celiac and non-celiac gluten sensitivity (NCGS) always warrent further investigation.

What probiotics should I take if I have celiac?

Dr. Rudert answers:

There are a variety of probiotics on the market and selecting one can be confusing! I individualize my recommendations based on the patient's symptoms. Some probiotics need to be refrigerated and others do not. They all vary in the type and amount of bacteria or yeast (good yeast) that they contain. There is definitely more to learn about which probiotics may be better suited to a specific problem or disease state. Ongoing studies may be found on For example multiple studies have been conducted looking at the efficacy of VSL #3 in patients with Ulcerative Colitis and in children and adults with "IBS". The use of bifidobacterium infantis, as well as other probiotic mixtures, has also been studied in celiac patients.

How can I be sure a probiotic is gluten-free?

Dr. Rudert answers:

Most probiotics are gluten free; however, I always recommend checking all medications and supplements. Some may contain a small amount of dairy and therefore may be unsuitable for individuals with lactose intolerance. The website is a fabulous source of information regarding the gluten free status of medications.

What if I feel worse after taking a probiotic and have more digestive distress?

Dr. Rudert answers:

If you feel worse after taking a probiotic you need to contact your healthcare provider. In my experience approximately 10% of patients tell me that their gas and bloating worsened prior to improving. In some individuals a change in dosage or switching to a different strain(s) may help.

How long should I continue taking probiotics?

Dr. Rudert answers:

Unless you are improving with yogurts or fermented foods I recommend taking probiotics long term.

Should I continue taking probiotics if I am also on an antibiotic?

Dr. Rudert answers:

Most probiotics will have decreased efficacy if taken close to the time of an antibiotic. The probiotic saccharomyces boulardii lyo (ex. Florastor) can be taken with an antibiotic since an antibiotic will not kill a yeast probiotic!

Can taking probiotics prevent celiac disease?

Dr. Rudert answers:

No one knows nor have they fully studied this question. It is known that in genetically predisposed individuals something triggers celiac disease. I think of it like a lock (your genetic predisposition) and a key (the trigger). To "turn on" celiac you have to have a key fit in to the lock. The key may be one or more of a variety of factors including the use of antibiotics.

EXTRA! Coming soon! Stay tuned for the latest updates from Dr. Rudert from the 4th Triennial Yale/Harvard Workshop on Probiotics, Marh 20, 2015, New Haven, CT!

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