A Beginner’s Guide to Choosing Probiotics
Most of you reading this have either taken probiotics or at some point thought about taking probiotics. If you haven’t, don’t sweat it!
I love to talk about this topic!
And like most topics in health and nutrition, there’s a lot of confusion and misunderstanding. Probiotics are no exception! In fact, they are undoubtedly one of the most misunderstood topics by healthcare professionals, let alone average consumers.
Today it’s my goal to clear up the confusion and shed some light on some of the issues surrounding probiotics.
Issues like knowing:
- When to use probiotics
- Which strains to use and at what dose
- Whether to use a single strain or a multi-strain probiotic
We’ll also explore some common strains that help with specific conditions like constipation and diarrhea.
But First…The Basics
Before jumping into the topic of probiotics, let’s first look at environment in your gut.
We have a vast community of bacteria, fungi, and viruses living inside our gut! This community is called the microbiota. The microbiota does a lot of things. It protects your digestive tract, strengthens your immune system and even influences the amount of calories to extract from the burger you ate last night!
But…
The microbiota can also promote weight gain, worsen your blood sugar, cause fatty liver and even trigger depression and anxiety.
Basically, when you take care of your microbiota good things happen. When you don’t, well, bad things happen!
So What is a Probiotic?
A probiotic, by definition, consists of single or multiple strains of bacteria that when consumed, provide you with a health benefit. A “health benefit” can include anything from regulating your bowel movements to decreasing inflammation, and even lifting your mood,
Grab a seat in your old grade 11 biology class for a moment as we explain how probiotics are differentiated between one another. It won’t be that painful, I promise!
Do you remember the terms genus and species? Probably not. I’ll explain.
I like using the car analogy here.
There are many makes of cars out there to choose from. You have Ford, Toyota, and BMW as general examples. This would be like the genus or the “family” of the probiotic strain.
With probiotics the two most common genus(es) would be Lactobacillus and Bifidobacterium.
Hopefully you’re still with me.
Now back to the car analogy, there are several models within each make of car. With Ford you have the Focus, the Fusion, the Explorer. Got it? Good! This is like the species of the probiotic strain.
Maybe you’ve heard of acidophilus? It was one of the first species discovered as a probiotic and is in many of the probiotic supplements on the market today.
So now we have a proper probiotic species:
Lactobacillus acidophilus
Just like there are a lot of differences between the make of a Ford and a Toyota, there are many differences between the model of a Ford Focus and a Ford Mustang.
But there’s more…
There is also a subspecies, which you’ll see following the species as a specific letter or number combination. This is the unique signature of a probiotic strain! Do you want the sedan or the hatchback? The luxury package or the basics?
Now when it comes to the dosage of a probiotic strain, it’s important to understand the numbers and what they mean. Colony forming units, or CFU’s for short, is the amount of a particular probiotic species that you’ll find in your supplement.
When you put all these things together it looks something like this on the bottle:
Bifidobacterium lactis HN019 5 Billion CFU
I used this particular example because this specific strain improves constipation. So when patients are sitting in front of me with sluggish bowels I look for strains that help with that problem.
I’m sure you have questions. like:
What does a probiotic actually do?
Once you consume probiotics they start making their way through the digestive tract. Sometimes the target is the stomach, other times it’s the small or large intestine. But along the way they temporarily affect your ecosystem. They do this by attaching to the digestive lining and interacting with your own bacteria and the gut immune system.
Generally speaking, probiotics:
- Help repair the intestinal barrier
- Prevent harmful bacteria from attaching to your intestines
- Spew out bacterial-killing substances that kill off harmful bacteria
- Talk to your gut immune cells by decreasing inflammation and reactivity (allergies)
- Regulate bowel movements
- Reduce abdominal pain
What are Shelf-stable Probiotics?
“Shelf-stable” is a term that was created to assure consumers that probiotics would not lose their effectiveness or be killed by not refrigerating them. This is becoming popular now that people want to be able take their probiotics on the go, through different time zones and to different climates.
What this actually means is that probiotic was created to contain enough live bacteria at the time of production to contain a minimum amount of live bacteria at the expiry date. In reality, no probiotics are completely shelf-stable!
Does that mean that they are better or hardier than non-shelf stable products? Absolutely not. In fact, there have been research studies showing that even ingesting dead bacteria may have probiotic effects. That’s crazy!
Ok, so I’ve put together a list of things I hear often about probiotics.
Maybe you’ve heard some of these too…
Misconception #1 – “Higher doses are better?”
It’s not that simple.
A question I get asked quite often is “What’s the dosage I should be taking?” And the answer is: it depends! It depends on what strains you are using. It depends on what condition you are using them for.
And at the end of the day, it depends on you as an individual. Even if you get the right strains for the right condition, sometimes they still don’t work!
There are probiotics that contain relatively small bacterial counts. There are also very high-dose probiotics on the market. And there’s everything in between.
We are a society that has come to think that if a little must be good, then way more must be better. This is absolutely not the case when it comes to probiotics!
Let’s look at this closer. Consider the following probiotic strain:
Lactobacillus reuteri DSM 17938
This particular strain is effective for treating infant colic and stomach pain in children. It also helps constipated adults and those being treated for H. pylori infection.
The dosage is 5-10 million CFUs . Considering most probiotic CFUs are in the billions, this is tiny!
Now compare that against the 7-strain probiotic VSL#3. This probiotic helps induce and maintain remission in ulcerative colitis, a devastating bowel disease.
The dosage used in VSL#3 studies was 900 billion CFUs per day!
Which brings me to our next common misconception:
Misconception #2 – “Multiple strains are more effective than single strains”
In the example above we saw a single strain probiotic strain work and a multi-strain probiotic work.
In truth, it doesn’t matter. What really matters is that they work!
There is plenty of research on using single strains for health benefits.
Saccharomyces boulardii lyo CNCM I-745 is one of them. It has several studies that show that it:
- Prevents and treats traveller’s diarrhea
- Improves symptoms of irritable bowel syndrome (IBS)
Or Lactobacillus plantarum 299v – It:
- Improves abdominal pain and bloating in irritable bowel syndrome
And there’s also:
Lactobacillus rhamnosus GG, which:
- Decreases symptoms of gas and bloating
- Helps improve the response of the influenza vaccine
- Decreases duration of viral or bacterial gut infection.
So don’t look at the number of strains. Look at what those strains do. Look at the research!
Misconception #3 – “Probiotics don’t work because they don’t stay in your gut”
While it’s true that most probiotics don’t stay in your gut for good, I’m not sure it matters! It’s helpful to compare the concept of taking a probiotic to the experience of being a tourist.
Here for a good time, not a long time…
As a tourist you visit, you eat the local food and you impact the local economy. After that, you leave and take your frivolous spending habits with you.
This is similar to what probiotics do. They aren’t meant to stay forever. Don’t take this to mean that probiotics don’t work, though. They benefit the local environment and then they move on.
Finally, some probiotic strains such as L. plantarum 299v have the ability to promote the growth of your own healthy bacteria. This has additional effects that may last beyond the time probiotics spend in the gut.
But probiotics certainly aren’t the be-all, end-all.
Misconception #4 – “Everyone should take a probiotic”
Listen, probiotics can be very useful for many people with digestive and non-digestive ailments.
There are times when taking a probiotic may not be suitable.
For example, probiotics have not demonstrated any benefit in Crohn’s Disease. Does that mean that no one with Crohn’s has ever benefited from probiotic use? Certainly not! But these people need to be very careful about anything they put in their body, let alone probiotics.
For these people it’s probably best to stick with probiotic-rich foods such as kimchi, sauerkraut, and organic cultured yogurt. Teaming up with a healthcare practitioner is key here.
Another condition to be cautious when using probiotics is in small intestinal bacterial overgrowth or SIBO. I wrote in detail about SIBO here.
Now that being said, thousands of studies have shown that probiotics are undoubtedly safe. Other than some temporary gas and bloating, you’re not likely to experience any negative side effects. So would it hurt to try? Probably not.
Pro Tip: Some probiotic supplements contain prebiotics. These are foods that feed your bacteria. However, some people have trouble with prebiotics, especially if they have IBS. They tend to cause gas and bloating so if you’re sensitive you may want to select a probiotic that doesn’t have this in it. You may see this listed on the ingredients as fructo-oligosaccharide or FOS. Choose probiotics that are FOS-free in these cases.
“But they work so well”
Some patients will get such amazing results with probiotics that they never want to come off them. And if they do, their symptoms often come back quickly.
Listen, probiotics aren’t the solution, they are a temporary tool to shift the environment within. A tool to help you start making those diet and lifestyle changes while feeling a bit more comfortable. Don’t use them as a crutch! That being said, a well-selected probiotic can make a big difference.
Needless to say that it’s important to get the right strain(s) if you are looking for a specific health outcome.
Bottom-Line:
When it comes to choosing a probiotic – do your research! Or go see someone who does theirs!
For more information on strain-specific probiotics check out: Probiotic Guide Canada. It’s available on the app store free of charge. It’s a scientific guide to probiotic use intended for doctors, but I think you should have access to it too!
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References:
- Mardini, Houssam E., and Alla Y. Grigorian. “Probiotic mix VSL# 3 is effective adjunctive therapy for mild to moderately active ulcerative colitis: a meta-analysis.” Inflammatory bowel diseases 20.9 (2014): 1562-1567.
- Miller, Larry E., and Arthur C. Ouwehand. “Probiotic supplementation decreases intestinal transit time: meta-analysis of randomized controlled trials.” World journal of gastroenterology: WJG 19.29 (2013): 4718.
- Gutiérrez-Castrellón, Pedro, et al. “Efficacy of lactobacillus reuteri DSM 17938 for infantile colic: systematic review with network meta-analysis.” Medicine 96.51 (2017).
- Ducrotté, Philippe, Prabha Sawant, and Venkataraman Jayanthi. “Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome.” World journal of gastroenterology: WJG 18.30 (2012): 4012.
- Szajewska, H., and M. Kołodziej. “Systematic review with meta‐analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic‐associated diarrhoea in children and adults.” Alimentary pharmacology & therapeutics 42.10 (2015): 1149-1157.