How Do I Choose A Probiotic?

Not all probiotics are created equal – how do I know what to look for?

Our gastrointestinal track is a delicately balanced environment that is affected by everything we put in our mouths.  We walk a tight rope of eubiosis (healthy balance) and dysbiosis (overabundance of potentially harmful organisms).    Our natural flora can be upset by a multitude of factors and affect our overall nutritional and health status.  In fact, everything from medications (such as antibiotics, oral contraceptives, etc.), poor diet, excessive alcohol intake, and lack of exercise can upset this balance and lead to poor immunity.

Enter probiotics.  Probiotics have been extensively studied and shown to have broad GI and immune benefits.  These benefits include; (1) increasing healthy bacteria following a period of imbalance; (2) supporting healthy bowel function; (3) increasing short-chain fatty acid production; (4) strengthening gut-immune barrier by promoting healthy gut mucosa; (5) aid in digestion of lactose and casein, and (6) help with overall detoxification.

Historically, we had plenty of probiotics in our diet from eating fresh foods from good soils and by fermenting foods to keep them from spoiling.  However, in today’s world of refrigeration and soaking our foods with chlorine, we have depleted our natural food supply of probiotics and thus, need to supplement.  Food such as miso, kefir, kimchi, pickles, sauerkraut, kombucha, and raw cheese are great natural sources of probiotics.

What are probiotics?

Probiotics enhance life – think the opposite of parasites.  They are single cell living organisms!  In general, we use the term probiotic to describe the following 3 organisms:  Bifidobacterium, Lactobacillus, and Saccharomyces.  Probiotics are marketed under brand names, however we typically refer to them by their generic name, which is further divided into a genus (Lactobacillus) and species (Acidophilus).  Many brand name probiotics simply place multiple different generic probiotics into one capsule to create a niche product, just like combination brand name medications have multiple generic medications in them.

Probiotics are similar to medications in that each probiotic, or strain, has a unique mechanism of action and effect.  Typically, the desired effects are a result of chemical(s) the probiotic releases and specifically, where this chemical exerts its activity.  Some desired effects are reduced inflammation, antidiarrheal effects, and immune boosting properties.

Bifidobacterium species is the most abundant “good bacteria” in the human GI-tract.  They produce acetic, butyric, and lactic acids, which are short-chain fatty acids.  These acids create a hostile living environment for harmful pathogens and thus help maintain intestinal microflora balance.

Lactobacillus species are rod-shaped bacteria that produce lactic acid from fermentable sugars such as fructose, galactose, glucose, and/or lactose.  They can withstand the acidic stomach environment and assists the body with increasing absorption of necessary minerals.

Saccharomyces is also known brewer’s yeast or baker’s yeast and is used to make beer, bread, and wine.  We typically only use the cerevisiae and boulardii species in medicine.  This probiotic plays a role in supporting immune defense by increasing levels of sigA, which creates a first line of defense that helps bind and clear harmful bacteria.

Why should I consider using probiotics?

Probiotics have been extensively researched and determined to potentially have a role in the following conditions:  (1) Improve digestive health, (2) Decrease antibiotic resistance, (3) Improve mental illness, (4) Boost immunity, (5) Decrease inflammation, (6) Protect against food allergies, (7) Help maintain healthy skin, (8) Lower blood pressure, (9) Improve the treatment of diabetes, (10) May improve non-alcoholic fatty liver disease

How and what to look for in a probiotic.

There is a plethora of probiotic supplements on the market and not all probiotics are created equal.  Here are some things to consider:

1. Temperature Stability

One of the most common questions we get is, should I choose a probiotic that requires refrigeration?  The answer is NO.  Potency of these refrigerated probiotics is affected if, at any point in the supply chain, they are manufactured, stored or shipped incorrectly.  Here is food for thought:  If a probiotic requires refrigeration to stay alive, how then will this live organism survive a high acid stomach environment that is 98.6oF?  Instead, look for a shelf stable product derived from soil with a short expiration date (< 1 year).

2. CFU Count

Look for a product with a high CFU, or “colony forming units” count.  In general, children should look for a product with 5-10 billion units and adults should look for a product with 10-20 billion units per day.  We do recommend discussing your particular situation with your provider to determine the best dose and course of action.

3. Trusted Manufacturer

Research the manufacturer of the probiotic you are interested in and consult with your pharmacist to determine the quality of the product.  Look for manufacturers that are free of wheat, gluten, soy, corn, animal or dairy products, fish, shellfish, peanuts, tree nuts, eggs, artificial colors, and artificial sweeteners or preservatives, as these are known irritants in our gut.  As always, we do not encourage purchasing any nutraceutical through mass online retailers, unless the vendors have been vetted by a pharmacist.  Adulteration (poorer quality or the addition of other, undisclosed substances) is a problem with the mass online retailers, and many manufacturing companies are trying, unsuccessfully, to crack down on unapproved retail sales.  This can lead to poor health outcomes.

Probiotics should be a staple in our modern-day health regimen.  Due to the loss of fermented products, the preparation of foods by soaking in chlorine, and stripping of nutrients in our soil, our modern “guts” are not getting the good buddies we need through diet alone.  Take the time to support your immune system and digestive health, among other things, by finding and taking a good probiotic daily.

 

 

Sources:

  1. Lipski E. Digestive Wellness. New Canaan (CT): Keats Publishing; 1996. p. 60-61.
  2. Bendali F, Madi N, Sadoun D. Beneficial effects of a strain of Lactobacillus paracasei subsp. paracasei in Staphylococcus aureus-induced intestinal and colonic injury. Int J Infect Dis. 2011 Nov;15(11):e787-94.
  3. Rodrigues AC, Cara DC, Fretez SH, Cunha FQ, Vieira EC, Nicoli JR, Vieira LQ. Saccharomyces boulardii stimulates sIgA production and the phagocytic system of gnotobiotic mice. J Appl Microbiol. 2000 Sep;89(3):404-14.
  4. Schoster A, Kokotovic B, Permin A, Pedersen PD, Bello FD, Guarabassi L. In vitro inhibition of Clostridium difficile and Clostridium perfringens by commercial probiotic strains. Anaerobe. 2013 Apr; 20:36-41.