A GUIDE FOR YOUR GUT: PROBIOTICS 101

Dispelling the confusion about probiotics.

You walk into your favorite health food store after just listening to a wellness podcast talking about how you should take probiotics to alter your gut microbiota and improve your health. Maybe you don’t even know what that means, but this girl you follow on Instagram just posted about it yesterday as well, so you’re ready to give it a shot. You ask the employee where the probiotics are. She points to an aisle with shelves and shelves of different probiotic supplement options. Some are refrigerated, a few are yogurts, and you even see one that says “women 65+”. How on earth are you supposed to pick the right one with all of these options?!? 

We are currently saturated with different information regarding our health. With new research and products constantly being put in our line of sight by marketers, influencers, even our trusted healthcare practitioners, it can be overwhelming to find the option or the answer you trust is best for your individual needs. It can even be overwhelming for me as a trusted healthcare practitioner sifting through the vast research current available on the topic of probiotics! Let me help to lighten the decision-making load off of you by providing you with a few facts to give you confidence in the world of probiotics. I’ll help you understand what to look for when choosing the right probiotic, to determine whether or not you even need to be taking probiotics, and to learn what potential benefits probiotics may offer you.

First things first: always consult with your doctor or dietitian before taking any supplements. A gastroenterologist and GI dietitian can help you determine whether or not probiotics are necessary in your routine if you are suffering from gastrointestinal symptoms.

How do I know if I should be taking a probiotic?

Although research shows that the consumption of probiotics is not necessarily harmful, it may not always be necessary. 

1. No GI symptoms, taking antibiotics for something else. And if you're a woman.

2. Chronic yeast infections

3.  Wait until after finish antibiotic. but can have yogurt. Specifically ones for vaginal bacteria

4. Compromised immune system (80% of immune cells live in gut)/skin disorders but otherwise healthy individual may want to try but consult first

   Do NOT: GI symptoms but unsure of cause (in middle of screened for diagnosis) don’t want to alter results/cause symptoms

   What are probiotics exactly?

   Probiotics are live bacteria that can provide health benefits such as restoring the balance of bacteria in the body with the theory that they help keep the harmful microbes in check. When the microbiome becomes unbalanced, this imbalance may lead to digestive issues. Probiotics may contain some antimicrobial compounds, stimulate an immune response such as the secretion of immunoglobulin-A (IgA), and compete with pathogens for nutrients by colonizing in the gut to help negate the growth of the pathogenic bacteria₂. Not all probiotics contain these mechanisms of action, but if you are looking for highly efficient probiotic, you’ll want them to have these functions. 

   What are some essential characteristics to look for in a probiotic?

   You want the probiotic supplement that you choose to survive through the upper gastrointestinal tract (GIT) all the way into your colon. In order for a probiotic to survive through the mouth, stomach, and small intestines, you want the strain to have gastric acid and bile salt stability. Some probiotics might say they contain 15 billion CFU (which stands for “colony-forming units”) on the label, but if the majority of those units do not last past the stomach, those large numbers aren’t doing much to benefit your health. In order to improve survival from the acidity in the stomach, some manufacturers use enteric coatings on their capsules, which can help with strains that demonstrate low tolerance to gastric acid₁. *Note: consult your doctor before taking a probiotic (or any medication or supplement) with enteric coatings if you have short bowel syndrome.* 

   You want a probiotic to have scientific substantiation - that is, clinical trials and scientific research that  validate its health effects. If the company did not take the time to perform research on their product to ensure its efficacy and are not willing to share that research with the consumer, it is unlikely their probiotic is anything but a complete waste of your money. 

   Some companies will include the species of probiotics their product contains, but if you’re looking for a probiotic to help treat a certain condition, you should look for the strain in the supplement as well, since different probiotic strains will have different actions. For example, through research, Lactobacillus rhamnosus GG was found to prevent viral gastroenteritis₃. While Lactobacillus rhamnosus GR-1 has shown to decrease the incidence of urinary tract infection (UTI)  in women who suffer from recurrent UTIs₃.  In order to better understand the difference between strains and species in probiotics, think of dogs: dogs are all part of the same species, but different species of dogs not only look different but also evolve to have different innate purposes and instinctual behaviors. For example, a maltese would not be trained in the police force and you will not find a golden retriever in Antarctica dog sledding. Just like different breeds of dogs have different strengths, different strains of probiotics have varying effectiveness in the body. 

   What is an effective dose to look for in a probiotic?

   Clinical trials have shown between 107 to 1011 CFUs per day is a strong dose to be listed on a probiotic; however, the number of CFUs in your probiotic really depends on the strength of the strains included in the probiotic and their ability to survive through the upper GIT₂. 

   What is the most effective form of probiotic supplement: liquid, powder, capsule?

   As far as convenience goes, most people prefer probiotics in their capsule form because it is the easiest to administer and has increased storage stability over liquid preparations. When the probiotics are turned into their powder form, they are freeze-dried which weakens the bacterial cellular wall and increases their risk of not being able to survive the acidity and bile salts in the gastrointestinal tract all the way to the colon. This is why most probiotics capsules have an enteric coating, to protect the harsh gastric conditions of the stomach. Although less convenient, the liquid form of probiotics is the most effective (specifically in a type of yogurt or kefir) because the acidity from the liquid increases the stomach’s pH and decreases gastric acid output. It is important to mention that regardless of which form of supplement you are using, you always want to choose a probiotic that is refrigerated (as this keeps it alive). Few research suggests that “dead” probiotics may still provide health benefits1 and live active cultures are much more effective in altering your gut microbiome and should be sought after. Even when traveling, bring your probiotic on your carry-on with you so the supplement is not subject to extreme temperature changes with air-travel and transfer them to a refrigerator as soon as you arrive at your destination. 

But I drink kombucha. Do I still need to take probiotic supplements?

Yes, kombucha does not contain nearly enough microorganisms to alter your gut microbiome. In fact, be cautious about your kombucha intake, especially if your drink contains more than 5g of sugar per serving. Kombucha can be a good alternative to soda or sugary juices, but should not be considered a supplemental source of nutrients. 

Still looking for more info?
Here is a list of few helpful resource guides for choosing probiotics: 

Visit AEProbio’s U.S. Probiotics Guide website or Download their Clinical Guide to Probiotics App

The International Scientific Association for Probiotics and Prebiotics (ISAPP)

Deciphering a Probiotic Label

References: 

1. Adams CA. The probiotic paradox: live and dead cells are biological response modifiers. Nutrition Research Reviews. 2010;23(1):37-46. doi:10.1017/s0954422410000090

2. Hawrelak J. Probiotics. In: Textbook of Natural Medicine. 4th ed. Elsevier Health Sciences; :979-989.

3. Szajewska H, Kotowska M, Mrukowicz JZ, Armanska M, Mikolajczyk W. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. The Journal of Pediatrics. 2001;138(3):361-365. doi:10.1067/mpd.2001.111321