Non-Hormonal Treatment of Menopausal Symptoms and Four Leaf Clovers

Photograph of Woman doing Yoga Courtesy of Invictus999
Healthy Menopausal Woman Photograph Courtesy of Kathy Wynn
Photograph of Rabbit in Clover Patch Courtesy of Jack Dagley

Menopausal symptoms, primarily hot flashes, can be treated with vitamins, specific foods (soy), non-estrogenic herbs (which stimulate the body’s own estrogen levels) and phytoestrogenic herbs (natural non-hormonal agents that have estrogen like effects in the body).

Phytoestrogenic agents should not be used in women with breast cancer or other hormonally related cancers or women with blood clots. Women at high risk of getting hormone related cancers or blood clots should also not use phytoestrogens.

Food that may Relieve Menopausal Symptoms

Soy foods have isoflavins, compounds which binds to the estrogen receptor and relieve hot flashes and other menopausal symptoms. Tofu, soy milk, tempeh and soy nuts are good sources of soy.

Oh Not Again, Exercise Helps Menopause??

Regular exercise is a must for women experiencing fatigue, weight gain and hot flashes related to menopause. 30 minutes of walking five days a week is recommended.

Vitamins Useful to Menopausal Women

400 IU vitamin E may help hot flashes and night sweats. Vitamin C helps the absorption of vitamin E. B vitamins may help menopausal symptoms. Calcium, magnesium and Vitamin D are essential to prevent thinning of bones in menopausal women. Probiotics (good bacteria) such as Lactobacillus acidophilus and Bifidobacter species help with metabolism and utilization of estrogen and may help reduce vaginal yeast infections.

Ligans in flaxseed oil can stabilize hormone levels in menopausal women. Evening primrose oil or black currant oil are sources of gamma-linolenic acid (GLA), an essential fatty acid that treats menopausal symptoms.

Non-Estrogen formulations

Black cohosh (Cumicifuga racemosa) does not have estrogenic activity. Women who have gone through natural menopause rather than surgical menopause (hysterectomy) seem to respond better to this agent. Black cohosh molecules bind to receptors in the human body which regulate body temperature and hot flashes.

Black Cohosh also helps mood swings and sleep disturbances common in menopausal women. It is commonly taken in tablet form and is known to have the equivalent to 20 mg of root per tablet. Recent trials found that around 40 milligrams per day of such tablets lessened menopause symptoms in 70% of the women tested.

Black Cohosh may reduce weight gained as a result of hormone imbalance. During menopause, as estrogen levels drop, the body looks for other stores of estrogen. Fat cells contain large amounts of this hormone. The body begins to produce more fat cells as a way to boost estrogen levels. Black cohosh balances estrogen levels. It may, in turn, stop the production of fat cells.

Macafem root is a non-estrogenic herb grown in the Andean plateaus of Peru. It increases level of natural hormones in the body. Macafem can help hot flashes, night sweats, mood swings, loss of libido and irregular periods.

Keishi-bukuryo-gan, a traditional formula made up of four herbs and a mushroom, is widely used in Japan for treatment of peri-menopausal hot flashes. A variant of it in the United States can be bought over the counter as H25. However, Keishi-bukuryo-gan has not been tested in women with hot flashes related to tamoxifen and other anti-estrogen medications. It is especially effective in women who always feel cold.


Ginkgo biloba boosts blood flow to the brain and improves concentration and cognitive function, which is important for menopausal women who often suffer from memory lapses. Ginkgo contains phytoestrogens (vegetable sources with a similar chemical structure to estrogen) which relace human hormones with plant substitutes. Because ginko is a phytoestrogen, it may increase the risk of breast cancer.

Dong quai helps painful menstrual periods and normalize irregular periods. It can increase risk of bleeding, so it should be used cautiously in women with heavy bleeding or on blood thinners. Dong quai is a phytoestrogen which may increase the risk of breast cancer

There are three common varieties of ginsing available: Native American, Korean and Chinese. They are phytoestrogens which have estrogen like effect in vagina and so they can help relieve vaginal dryness common in menopausal women. Korean ginseng is especially popular among athletes for improving performance and stamina. Ginseng is used to treat decreased libido common in menopausal women.

Red Clover (Trifolium Pratensei) is a phytoestrogen which contains the chemical compound called coumarins, which can thin blood. Use cautiously in women on blood thinners. Red Clover is used in China and Russia to treat upper respiratory illnesses. Ancient Romans and Greeks wore clover on their chest for good luck and as a way to ward off evil. Four leaf clovers felt to be especially lucky.

Last Updated by Dr. Vee on February 18, 2011

Lavender and Tea Tree Oil May Cause Breast Development in Young Boys

Lavender and Tea Tree Oils May Mimic Estrogen Effects in Boys

A study published in  the New England Journal of Medicine suggested that the use of topical agents containing lavender oil and/or tea tree oil may cause breast tissue (called gynecomastia) to develop in young boys. This finding was reported by Clifford Bloch, M.D., a pediatric endocrinologist at the University of Colorado at Denver and Health Science Center’s School of Medicine. 

This doctor found that three of his young male patients with unexplained breast development (gynecomastia) had all used lotions, creams, shampoos, styling products or soap with lavender or tea tree oil in them.  Once these products were stopped, the gynecomastia also resolved.

Researchers who conducted laboratory studies at t he National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health (NIH), confirmed that there may be an association between the use of products containing these oils and prepubertal breast development in boys, but cautioned more research is needed.  Large scale epidemiologic studies are needed to determine the association of lavender and tea tree oils and gynecomastia.

Ken Korach, Ph.D., chief, Laboratory Reproductive and Developmental Toxicology at NIEHS confirmed that his laboratory studies confirmed that pure lavender and tea tree oils can indeed mimic the effects of the female hormone estrogen and inhibit the effects of androgens (male hormones).

Interestingly enough, the male and female hormone levels in the three boys with gynecomastia were not changed by their exposure to lavender or tea tree oil. Therefore, Derek Henley, Ph.D., the lead NIEHS author on the study hypothesized that lavender and tea tree oils may be  “endocrine disruptors.”    Endocrine disruptors are agents that interfere with the activity of hormones but not affect the levels of the hormones themselves.  They may alter signaling of the hormones, resulting in abnormal endocrine effects.

Studies are need to decide whether lavender and tea tree oils have the same effects in females or adults.

The National Institute of Environmental Health Sciences (NIEHS),  a part of the National Institutes of Health, supports research to understand the effects of the environment on human health. 


Henley DV, Lipson N, Korach KS, Bloch CA 2007 Prebubertal gynecomastia linked to lavender and tea tree oils. New England Journal of Medicine 365(5): 479-485  

 Photograph of Australian Tea Tree courtesy of J. Brew.

Last updated April 18, 2010 by Dr. Vee


St.John’s Wort–The P450 Superwoman


St. John’s Wort is a widely used botanical that has many interactions with commonly prescribed medications.  In fact the the United States Food and Drug Administration issued a  health advisory about St. John’s Wort.

St. John’s Wort increases the level of enzyme system in the liver called the P450 system.  In medical school, the P450 system seemed to be the super enzyme that accomplished everything–wife, mother, powerful leader –oh sorry, that was Condeleeza Rice…Actually the P450 is responsible for breaking down many toxins in the body.  If you are interested in trivia, or in taking my medical school biochemistry tests for me, you would be interested to know that St. John’s Wort induces the cytochrome P450 isoenzymes CYP3A4, CYP2C9, CYP1A2 and the transport protein P-glycoprotein.  When these cytochrome P450 enzyme levels are increased, the breakdown of certain medicines is enhanced.  These medications include warfarin, cyclosporine, digoxin, theophylline, HIV protease inhibitors and birth control pills.  So blood concentrations of these medications may be decreased if you are also taking St. John’s Wort. 

Make sure you discuss St. John’s Wort or ANY supplement or herbal remedy you may be taking with your doctor.  It may be that the levels of other medicines you are taking may be higher or lower than desired because of interactions with St. John’s Wort.
Last Updated March 24, 2010

Statins and Beta Blockers Deplete CoQ10


Coenzyme Q10 is a natural substance found in abudance in cells of the body that provides energy to the body and helps the immune system.  CoQ10 also acts as an antioxidant in the body.  Antioxidants are substances that attack and remove free radicals, dangerous substances which cause damage to cells and can eventually result in cancer, aging or cell death.  CoQ10 protect cells from stress from environmental toxins (e.g. cigarette smoke) or aging.  It is in this way that Coenzyme Q10 is believed to help the body fight cancer, prevent heart disease, and combat aging. 

CoQ10 is found in mitochondria, the parts of cells that generate energy. CoQ10 is involved in the generation of energy called adenosine triphosphate (ATP) in cells.  ATP is the energy currency that allows cells to carry out all their myriad functions, including muscle contraction, protein synthesis and other vital cell functions.

Two forms of CoQ10 exist. The more common form is called ubiquinone. The active or oxidized form of CoQ10 is called ubiquinol.  Young people convert ubiquinone to the active component ubiquinol quite readily.  However, ubiquinone is less easily converted to ubiquinol as people get older.  Until recently, ubiquinol was unstable and could not be manufactured as a supplement.  Now ubiquinol is available, but is typically more expensive than the ubiquinone form.

CoQ10 are found in large numbers in the power centers of the body, the liver and heart.  In the liver, CoQ10 is made in a pathway similar to the way cholesterol is made.  So when a person is on a statin, which inhibits an important enzyme that makes cholesterol, the CoQ10 pathway is also impaired.  It is believed that two important classes of medications, the statins (simvastatin, atorvastatin, pravastatin, lovastatin) and beta blockers (atenolol, metoprolol) decrease (up to 40 %) the production of CoQ10 in the body.

Eating antioxidants in Super Foods such as pomegranate juice is a good way to replenish CoQ10 in the body. Some experts feel that older patients on statins or beta blockers should take CoQ10 supplements to replace the reduced levels of CoQ10 in cells.  Some experts feel that people who have high blood pressure should consider supplementation with CoQ10 as well as Vitamin D3.  Athletes (and wannabe athletes) may want to consider adding CoQ10 supplementation to optimized exercise endurance and muscle recovery.

Last updated March 19, 2010 by Dr. Vee

Top 12 Must-Have Items for a Senior’s Medicine Cabinet

1.  Advanced Directives–Also known as a Living Will.  Includes your determination of your Healthcare Surrogate, or who you want to make medical decisions for you. 

If you have a “DNR” form that specifies that you do not want paramedics to resuscitate you in the event your heart stops beating or lungs stop breathing, this should be prominently placed near the entrance of your home or attached to your refrigerator.

2.  List of your medications, including specific doses.  Include medication allergies, including any allergy to latex.

According to a survey by AARP and the National Institutes of Health (NIH), two-thirds of people aged 50 and older use some form of complementary and alternative medicine (CAM). Less than one-third of those who use CAM talk with their doctors about it. Remember that supplements are not evaluated by the Food and Drug Administration.

The term Medicine Cabinet is used in the title of this article to emphasize the fact that supplements should be treated like other medicines. Share with your doctor any supplements you may be taking to find out any side effects or interactions with other medicines you may be taking.

3.  First Aid Kit with topical antibiotic, alcohol pads, gauze pads, paper tape, Ace wrap and bandages.

4.   I call Vitamin D the Superstar Supplement–studies suggest it may reduce the risk of high blood pressure, diabetes and certain cancers.   Vitamin D helps the absorption of calcium in the stomach.  Many more people are vitamin D deficient than previously known.  Vitamin D is important for healthy bones.  It helps the absorption of calcium in the stomach.

5.  Calcium is important to prevent osteoporosis or thinning of the bones.  Calcium supplements typically contain vitamin D as well. 

6.   Continuing this discussion about healthy bones, the combination of glucosamine and chondroitin were shown to improve the pain of moderate to severe arthritis, but was no better than placebo in mild arthritis in the GAIT study  funded by the National Center for Complementary and Alternative Medicine.

7.  Healthy joints may also benefit with omega-3 fatty acids, more commonly known as “fish oil.”  Studies show that omega-3 fatty acids may help patients with an inflammatory arthritis called rheumatoid arthritis. 

Omega 3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have also been found to improve memory. 

Fish oil is best known for helping increase the good cholesterol in the body and lowering  bad cholesterol and triglycerides (fats).  The best way to get omega 3 fatty acids is to eat fatty fish such as  salmon, sardines, tuna or mackerel twice a week. 

A landmark study conducted in Italy showed that omega 3 fatty acid supplementation after a heart attack helped reduce the risk of recurrent heart attacks.    The American Heart Association recommends 500 mg of omega 3 fatty acids daily for healthy people and 1 gm of omega 3 fatty acids for people who have known coronary artery disease. Check with your doctor before taking omega 3 fatty acids because they may increase the risk of bleeding.

8.   Cholesterol levels can also be improved by eating fiber in the diet.  The best sources of fiber are whole grains such as barley, oat bran or quinoa.   Fiber also helps prevent diverticulosis (small pouches inside the large intestine).   The more fat in the diet, the more diverticula that form.  They can become inflamed and infected and may even require surgical removal of part of the colon.    Some patients with irritable bowel syndrome or constipation benefit with fiber supplements in their diet. It is very important to drink lots of water when taking fiber supplements–approximately 64 ounces a day. 

9.    Probiotics are supplements that also help maintain good colon health.  Probiotics are microorganisms which replenish the good bacteria that normally live in our colon or large intestine.  Probiotics are especially helpful when you have a stomach virus or have to take antibiotics.

10.  A study carried out by Harvard Medical School researchers showed that regular use of aspirin after developing colorectal cancer decreased the risk of death from colon cancer.  The most common use for aspirin, though, is to prevent heart attack and stroke.  The U. S. Preventive Services Task Force (USPSTF) encourages men aged 45-79 to consider taking low dose aspirin to prevent heart attack. Women ages 55-79 should consider aspirin therapy to prevent stroke.

Like other blood thinners, aspirin should not be used by patients who have had bleeding ulcers, patients over the age of 80 (except under a doctor’s supervision), patients with bleeding strokes or people at high risk for falls.  Always consult your doctor before starting aspirin.

11.  Lutein is an antioxidant supplement which has been shown to  help slow down or prevent vision loss in patients with age related macular degeneration.   The macula is the part of the back of the eye called the retina which is involved in central vision.  

Age related macular degeneration leads to loss of central vision, sparing the peripheral vision. The macula is the part of the retina that is also most sensitive to blue light the part of the visible light spectrum that, along with ultraviolet light, can damage your eyes.  Sunglasses also prevent  penetration of blue and ultraviolet light to the macula.

12.  Sunblock SPF at least 15 should be used daily to exposed skin.  Broad spectrum sunblock prevents ultraviolet A and ultraviolet B rays.  UVA rays cause premature aging of the skin.  UVB rays can cause sunburns.  

Exposure to both types of ultraviolet rays can lead to the development of skin cancer, including melanoma, a very serious type of skin cancer.   Look for agents that contain titanium and zinc oxide. Most people do not use as much sunblock as needed to protect the skin.   One ounce, enough to fill a shot glass, is  needed to protect each of the exposed parts of the body. 

Sunblock should be rubbed into the skin, especially on the face, ears, arms and hands, 15-30 minutes before sun exposure.  It must be re-applied frequently, every two hours, even the water-resistant kind.   

The American Academy of Dermatology recommends daily use of sunblock to exposed areas of the body, not just on days you are out in the sun.   On cloudy days, up to 80% of the sun’s rays are still present to cause sun damage. This article is for informational purposes only and should not substitute for medical advice from your healthcare provider.

The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment.

Last updated May 1, 2010 by Dr. Vee

Probiotics, Prebiotics and Symbiotics

Probiotics playing Golf

In 2002, a joint statement published by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.” Most commercially available probiotic products are strains of Bifidobacterium or Lactobacillus bacteria or Saccharomyces yeast. Lactobacillus caseii rhamnous GG (Whew! Fortunately abbreviated as LGG) is the most extensively studied bacterial probiotic.

Prebiotics are substances (such as certain carbohydrate sugars) that are not digested, and when they reach the large intestine, they stimulate the growth of beneficial bacteria. Breast milk has a large supply of healthy prebiotic carbohydrates. Symbiotics are a combination of probiotics and prebiotics.

GI Tract


The Gut–Where Probiotics work

When a baby is born, there are no bacteria in the colon. However, shortly after birth, bacteria start living (colonizing) in the large intestine. Breastfed babies have different bacteria (flora) than formula fed babies, which experts hypothesize may contribute to the fewer diarrheal illnesses experienced by breastfed babies. Formula fed babies tend to colonize more harmful strains of bacteria as normal residents of the colon. In certain circumstances, the harmful bacteria can cause problems.

Probiotics show promising positive effects in certain gastrointestinal and allergic diseases. Probiotics and Diarrheal Illnesses Probiotics show benefit in people who have a mild to moderate case of a stomach virus. They also help prevent antibiotic-associated diarrhea (AAD). Various over the counter Saccharomyces and Lactobacilli supplements are available to treat these types of diarrhea. Evidence suggests that probiotics need to be taken early in the course of diarrhea in order to be effective.

Bifidobacterium has been shown to have some effect in preventing relapses of ulcerative colitis in adults.


Probiotics and Colic


Lactobacillus reuteri has been shown to be highly effective in treating colic in babies. In fact, Lactobacillus reuteri worked better than the anti-gas drops that are the most often used medication to treat infantile colic.

There has been a great deal of research on probiotics and allergic illnesses. Studies have shown that LGG given to pregnant women and infants (in breast milk or LGG supplemented formula) may reduce the development or severity of eczema related to cow’s milk allergy in children.

Fluorescent green probiotics

Every spring, hay fever suffers search for a new way to treat their runny noses, sinus congestion and itchy eyes. Unfortunately, the evidence to date suggests that probiotics do not help prevent or treat seasonal allergic rhinitis or environmental allergies such as to pet dander.

Probiotics Cautions

Remember, probiotics are live bacteria, and they should be taken with the same precautions as any medicine or supplement. The risks and benefits of ingesting live bacterial or yeast cultures should be weighed carefully. Caution must be exercised with the use of probiotics in immunocompromised patients (patients with cancer or immune system defects). Consult your physician before using any probiotic.

Probiotics are not regulated by FDA

So why are probiotics more effective than say, plain old yogurt? Probiotics contain much larger amount of bacteria (over 108 microorganisms per gram of supplement) than yogurt. Remember, though, probiotics are not regulated by the Food and Drug Administration (FDA), and studies have shown significant variability in the number of colony forming units available in various probiotic formulations.

Reference: Food and Agriculture Organization, World Health Organization. The Food and Agriculture Organization of the United Nations and the World Health Organization Joint FAO/WHO expert consultation on evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria, FAO/WHO Report No. 10-1-2001.

This article is for informational purposes only and should not substitute for medical advice from your healthcare provider. The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment.

Bad Bacteria Cartoon

Last updated August 22, 2009 by Dr. Vee

Vitamin D Deficiency in Children and Adolescents


milk vitamin DRecent studies show an alarming lack of vitamin D, also called cholecalciferol, in American children and adolescents.

Vitamin D is important for the development of strong bones. Vitamin D deficiency can lead to rickets (weak, deformed bones) in infants and children. It also contributes to osteoporosis(thinning of the bones) in post-menopausal women. Vitamin D deficiency may also contribute to high blood pressure, diabetes and certain cancers, although no definite causal link has been proven.

Vitamin D Made in the Skin from Sunlight

Vitamin D is available to the body in two different ways. Sun exposure helps the skin make vitamin D.  Ultraviolet B (UVB) waves help formation of vitamin D in the skin, but UVB rays are also responsible for the burning effects of the sun.

Not surprisingly, vitamin D deficiency is more common in northern parts of the country, where there is less sunlight. Melanin, the pigment in the skin, as well as sunblock applied to skin, can decrease the absorption of vitamin D. The more melanin in the skin, the darker the pigment of the skin, and the less vitamin D that is absorbed.

Regular application of sunblock to the skin will also decrease absorption of sun.  The American Academy of Dermatology does not recommend stopping the use of sunblock to allow the absorption of vitamin D, since the ultraviolet B rays can increase the risk of skin cancers.

Vitamin D can be Absorbed in the Stomach

200 IU (international units) of vitamin D is the daily recommended intake of vitamin D in children and adolescents. Post-menopausal women should have at least 400 IU a day to prevent thinning of the bones. Many experts feel that this recommendation is too conservative, and that post-menopausal women need at least 1000 IU daily to prevent/treat osteoporosis.

vitamin D sources

Fish, vegetables, and milk and cereal fortified with vitamin D are all good sources of vitamin D. However, a child would have to drink the equivalent of half a liter of milk a day to get recommended amounts of vitamin D. Vitamin D is important because it helps the absorption of calcium by the gut.

Vitamin D is Converted into 25 Hydroxyvitamin D, 25 (OH) D (Calcidiol)

Once vitamin D is absorbed by the skin or in the stomach, it is converted to a molecule called 25 hydroxyvitamin D (shortened as 25 (OH) D or calcidiol), in the liver. Although it is not routinely checked, 25 (OH) D can be measured by a blood test. 25 (OH) D is then converted to another molecule in the kidney. So it is not surprising that children and adults with kidney failure are prone to severe thinning of the bone. Vitamin D is then stored in the fat in the body once it is converted by the liver and kidney.

Vitamin D Deficiency is Common in Children and Adolescents

Currently, a level of < 11 ng/ml is defined as vitamin D deficiency. Many experts feel that this threshold is too low, and that the negative effects of vitamin D deficiency on bones can occur at levels of 20 ng/l or higher. A number of studies have shown that vitamin D deficiency is more common than previously thought. Three main factors play a role in vitamin D deficiency in children and adolescents: race, gender and body-mass index (BMI, a measure of obesity). Girls are twice as likely as boys to have vitamin D deficiency. Darker pigmented children are more likely to have vitamin D deficiency. 25 (OH) D levels decrease as BMI (weight) increases.

The Highest Rate of 25 (OH) D Deficiency is Seen in Overweight African American Adolscents

In the United States, up to 2 % of all children have levels of 25 (OH) D less than 11 ng/ml, and 14 % have less than 20 ng/ml. Even more concerning, 11-50 % of African American teenagers in the United States may have 25 hydroxy D deficiency (depending on how deficiency is defined). This is a startling statistic. In one study, African American adolescents were found to be twenty times as likely as Caucasion adolescents to have vitamin D deficiency. The risk of vitamin D deficiency in Hispanic and Asian adolescents is also higher than in Caucasions. Being overweight increases the risk of vitamin D deficiency by 75 %. The highest rate of 25 (OH) deficiency is seen in overweight African American adolescent girls.

Letter D on Plate

Vitamin D Supplementation in the Diet

It is unclear how vitamin D deficiency in adolescents will affect health when they become adults. Interestingly, in post-menopausal women, thin Caucasians are at highest risk for osteoporosis and bone fractures. It seems prudent to maximize food intake of vitamin D or to consider taking a vitamin D supplement if not enough vitamin D is consumed in the diet. In the future, it may be useful to measure 25 (OH) D levels in high risk adolescents.


Saintonge, Sandy, Bang, Heejung, Gerber, Linda. Implications of a New Definition of Vitamin D Deficiency in a Multiracial US Adolescent Population: The National Health and Nutrition Examination Survey III. Pediatrics 2009; Vol. 123, Number 3: 797.

Legal Disclaimer: This article is for informational purposes only and should not substitute for medical advice from your healthcare provider. The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment if you have any medical concerns.

Updated January 6, 2011 by Dr. Vee

Probiotics Prevent Diarrhea Related to Antibiotics

Did you know that taking probiotics will help prevent side effects related to antibiotics?   Antibiotics do not treat the common cold.  They do, however, kill the germs that cause sinus infections, skin infections and bladder infections.  But like everything else in life, antibiotics can have a downside.  They also kill the good bacteria that live in your gut and that in turn can cause resistant strains of dangerous bacteria to overgrow.


Probiotics are live organisms, usually high colony counts of certain yeast or bacteria, which help regulate your gut again.  Think of probiotic strains as “friendly bacteria.”  Now, you can eat yogurt to give back the good microorganisms to your gut, but you would have to eat ten times the amount of yogurt to get the number of organisms normally found in an over the counter probiotic supplement. 


So the next time you have an infection, talk it over with your doctor.  If it’s clear that you really need an antibiotic, ask your doctor if probiotics are a good option to take along with the antibiotic.

Last updated April 11, 2009