Pass the probiotics, please

by Christina on October 25, 2016

I spend a lot of my days talking about probiotics.

They come up when I’m prescribing antibiotics (since antibiotics also kill many of the natural “good” bacteria in the gut), when talking about GI symptoms (irritable bowel, bloating, constipation), when talking about weight loss and obesity, and when seeing babies and kids with constipation.

So much research has been coming out on this and I’m loving it. A study was out recently from UCSF about allergies and asthma being linked with the diversity of infant gut bacteria — “Variations in just four kinds of bacteria—Bifidobacteria, Lactobacillus, Faecalibacterium, and Akkermansi—heightened the risk of allergies and asthma” (study here).

There are LOTS of probiotic strains and species making it quickly overwhelming. The main groups are Lactobacillus and Bifidobacterium, and then there are multiple species and strains under these groups.

The best way to get probiotics is through fermented food, such as:

  • Yogurt
  • Kefir
  • Kimchi
  • Miso
  • Sauerkraut
  • Kombucha
  • Tempeh
  • Natto

But, most of us don’t eat too many of these.


The other option is taking a probiotic supplement, and there are a lot to chose from. Common single strain brands include Align, Florastor and Culturelle. Multi-strain probiotics include Jarro-Dophilus and Garden of Life RAW probiotics . 

There’s a lot still to learn about which specific strains might be helpful for certain conditions. One of the most interesting areas to me is using probiotics for obesity treatment — studies such as these suggest certain strains could be helpful:

“Lactobacillus gasseri SBT 2055, Lactobacillus rhamnosus ATCC 53103, and the combination of L. rhamnosus ATCC 53102 and Bifidobacterium lactis Bb12 may reduce adiposity, body weight, and weight gain.”

Our family has been trying to eat more fermented foods. This can be hard with a toddler, but we have some success with yogurt, kefir, and even kimchi.

We’ve also been occasionally giving our kids baby Jarro-Dophilus to help their microbiome:jarro-dophilusHow do you get your probiotics?


5 things I like about being a family doc

by Christina on October 19, 2016

My baby is 12 weeks old and I’m back to work. Oh, transitions….

There’s a lot to complain about in primary care (maternity leave being one of them!) and I’ll be one of the first to name some of the issues I face daily.

But, there are also a lot of great things about being a primary care doctor, and I’m trying to appreciate them more. I’ve been trying to express more gratitude in general.


So today, instead of complaining, here are 5 things I like about being a primary care doctor:

  1. I truly look forward to seeing many of my patients. Yes, having over 3,300 patients on my panel is far too many, but I do feel lucky to get to know many of them.
  2. I get to take people off of medications. Many people come to me on a long list of medications. Some may be needed long-term, but some can often be discontinued once we work on addressing underlying causes and lifestyle changes.
  3. I get to talk a lot about food as medicine. Our food and lifestyle choices have the power to lead to disease or to optimize health, and I see people reverse diabetes, lower blood pressure, and improve cholesterol levels without medication.
  4. I get to care for a newborn and 97 year-old in the same day. Being the doctor for people through all phases of life means moving from infant development to erectile dysfunction to menopause to depression to end of life care all in one afternoon. It doesn’t get boring and I’m always learning.
  5. I get to see the big picture. Healthcare these days is frustratingly fragmented with doctors assigned to each body part or organ. But as the family doc, I pull together the constellation of symptoms, specialist input, studies done, and patient goals and desires to help come up with an overarching picture and plan.

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Why not to take Calcium supplements

by Christina on October 14, 2016

Yesterday, my younger sister texted me asking if I think it’s okay for her to take a chocolate calcium supplement, and that actually she likes the taste so much that she has been having two per day.

I quickly texted her back — no, not okay!

As I review medications and supplements with my patients, I often discover they are taking a calcium supplement because they think this is good for their bones. I then spend a lot of time recommending they stop their supplement, and instead make sure to get sufficient calcium through food.

There’s more evidence coming out that calcium supplementation may actually be dangerous. This study published this week looked at calcium intake (through both diet and supplementation) of over 2700 patients and compared coronary artery CT scans over a 10 year period.

They found that taking a calcium supplement was associated with an increased risk of coronary artery calcification. Interestingly though, it seems that only the calcium supplements increase risk, while a calcium-rich diet was protective.

Here’s a nice article in Science Daily summarizing the study’s findings:calcium

The bottom line — try to get the calcium you need from your food. For postmenopausal women this is 1200 mg per day. For other women this is 1000 mg per day. For men this is 1000 mg per day (men over 70: 1200mg per day).

It is not hard to meet these requirements with a balanced, whole foods diet. Food sources of calcium include dairy products, leafy greens, nuts and seeds, soy and almond milk, cereals, and fish.

Here are some examples of foods and their estimated calcium amounts:

  • Yogurt (1 cup): 450 mg
  • Soy/Almond milk (1 cup): 200-400 mg
  • Spinach (1 cup cooked): 240 mg
  • Broccoli (1 cup cooked): 180 mg
  • Figs (dried, 1 cup ): 300 mg
  • Tofu (4 oz, calcium set): 250-750 mg
  • White beans (1/2 cup cooked): 70 mg
  • Almonds (1 oz): 80 mg
  • Sesame seeds (1 oz): 280 mg

(More details on dietary sources of calcium from UCSF here and NIH here)