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  • Writer's pictureGilda Gilak, DC, MS

Probiotics, a simple guide to choose the probiotics that work for you.

Updated: May 17, 2022


Before we get started, there are a couple of terminologies that we need to be familiar with:

What are probiotics?

Probiotics mean life. They are microorganisms that yield health benefits. Naturally, they live in our GI tracts. Still, due to various reasons such as: illnesses, lifestyles, diets, and antibiotics use, from time to time, we may need to take specific probiotics to improve health. Humans have been taking probiotics in fermented food for many years, but modern-day and new research lead us to utilize them in supplement form.

What is Strain?

Microbiologists use strains to identify microbes; usually, two names are given, such as Lactobacillus( last name), Rhamnosus( first name), more specific GG. Sometimes scientists adjust and change the names of these microbes. What is crucial to know is that not all strains are created equally ait is impertinent to choose a correct strain. Otherwise, the product you are using will not have the benefits; using proper Strain directly impacts the effectiveness of probiotics. For example, Lactobacillus Rhamnosus GG is used for the treatment of IBD.


What is a microbiome?

The microbiome is a term used for a range of ( thousands) beneficial bacteria that already exist in our GI tract. Think of a rainforest, the amount and the identity of these microorganisms still is under investigation, and science is at its preliminary stages to discover their full benefits. Some of these bacteria are beneficial, while some are opportunistic pathogens. They compete for space in our systems( think of a parking space); therefore, it is essential to maintain harmony between them. The goal is to have more beneficial bacteria than opportunistic pathogens for a healthy GI system.


Probiotics are those bacteria that we could consume either as a natural form in fermented foods such as ( yogurt, kimchi, kombucha, Keifer, etc.) or, as supplements mainly as a dried freeze microorganism or newer forms are spore-forming bacterias.


Prebiotics are mainly complex sugar, specifically Fructo-oligosaccharides that are ingested by probiotics. A good example is Inulin. Probiotics are food for probiotics and can be used after proper inoculation of probiotics. Although certain companies contain both pro and pre-biotics in the same formula, I find it is best to take probiotic first and after a week adding probiotics certainly helps maintaining gut microflora.


The efficacy of probiotics depends on various criteria:

1-The Strain:

The kind we are consuming has to be related to the condition that we want to improve. Also, where the strains are coming from, having human origin is crucial to the efficacy of the probiotic products. Consumerlab has a great breakdown of which probiotic works for which condition. While some strains help with GI issues such as bloating, diarrhea, IBS, others help with respiratory disorders.

2-The Viability:

These microbes need to be alive when we consume them. In addition, they need to survive through the GI tract ( for example: tolerating stomach acid and biles), also must have the ability to adhere to the intestinal mucosa to grow and cultivate. As consumers, we only can rely upon third-party verifications such as Consumer labs to find out if the products are viable. While most Lactobacillus, Bifidobacterium, and Streptococcus species do not require coating and can withstand stomach acids, studies have found 10-20% of them die when not coated.

3- The amount( How much to consume?)

CFU is the unit found on the bottle, which means Colony Forming Unite per day. The magic number for probiotics is 10 to the power of 7 or 11 days (billion). The dose depends on strains, and although various strains require different amounts, they have to have 10 billion to be effective. When using a probiotic with multiple strains in them, each must contain ten billion.

Also, always verify your products for clinical safety. Clinical documentation on them is done through third-party verification labs, and having access to these third parties could be an excellent tool for consumers to use.

What are the common conditions to use probiotic for?

Let's talk about common strains and their use. Traditionally probiotics were used for GI infection, diarrhea, IBD, IBS, and other GI-related issues. In the past, Strains used in dealing with GI-related issues have been: Lactobacillus and bifidobacterium.

For more updated research, resources such as: probioticadvisor are a great place to look for the most up-to-date research.

Novel use, researchers have found benefits in using probiotics for Mastitis, Endometriosis, Preventing Gestational diabetes, improve the immune system, Postpartum obesity, Atopic eczema, Anxiety and depression, Weight loss. Here is a list of strains that are useful when dealing with GI issues:

Saccharomyces cerevisiae has been shown to improve symptoms of IBS.

How and when to take probiotics?

It is best to take probiotics after a meal, especially a medium-fat meal, to take advantage of alkalinity to the stomach. Also, Using yogurt is a suitable medium( ideal transportation system for bacteria to survive the stomach and small intestine)

While dealing with a specific issue, you want to limit your choice to the Strain that is specifically beneficial for your conditions. For maintenance, it is best to use multiple strain products. The product, however, must contain the following strains: Lactobacillus acidophilus and Bifidobacterium lactis. For treatment of diarrhea in adults and children, Lactobacillus GG and Lactobacillus reuteri are beneficial.

A Randomized, double-blind, and placebo-controlled study by Berggrena et al. l was conducted in 2011, which showed using probiotics strains of Lactobacillus Plantarum(HEAL9 and Lactobacillus Paracasei reduces the risk of common cold infections.

Bifidobacterium lactisB420 Strain shows to have an impact on weight control.


Common Myth exist in regards to consumption of probiotics:


Myth#1 Take Probiotics on an empty stomach. This myth is incorrect. Probiotics should be taken with food, and especially food with high-fat content tolerates stomach acid better.

Myth #2 Don't take probiotics while taking antibiotics. This myth is also incorrect. Taking probiotics while taking antibiotics decreases antibiotic side effects and attenuates antibiotics' impact on the gut microbiome.

Myth #3 Foods ( fermented foods) are the superior form of probiotic. Numerous research studies indicate that certain supplements have higher quality and quantity of microorganisms than what is found in natural form in food.


One factor remains to consider, certain microorganisms are only found endogenously and can not be replaced by supplements; therefore, taking probiotics can't replace them. However, it could ensure beneficial microorganisms get back to the parking lot theory and occupying spaces. As long as beneficial bacteria outgrow the pathogenic ones, our GI will remain healthy and functional.


References:

1-Berggren A, Lazou Ahrén I, Larsson N, Önning G. Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections. Eur J Nutr. 2011 Apr;50(3):203-10. doi: 10.1007/s00394-010-0127-6. Epub 2010 Aug 28. PMID: 20803023.

2-Zmora N, Zilberman-Schapira G, Suez J, Mor U, Dori-Bachash M, Bashiardes S, Kotler E, Zur M, Regev-Lehavi D, Brik RB, Federici S, Cohen Y, Linevsky R, Rothschild D, Moor AE, Ben-Moshe S, Harmelin A, Itzkovitz S, Maharshak N, Shibolet O, Shapiro H, Pevsner-Fischer M, Sharon I, Halpern Z, Segal E, Elinav E. Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features. Cell. 2018 Sep 6;174(6):1388-1405.e21. doi: 10.1016/j.cell.2018.08.041. PMID: 30193112.

3-Charbonneau D, Gibb RD, Quigley EM. Fecal excretion of Bifidobacterium infantis 35624 and changes in fecal microbiota after eight weeks of oral supplementation with encapsulated probiotic. Gut Microbes. 2013;4(3):201-211. doi:10.4161/gmic.24196

4-Kadooka Y, Sato M, Imaizumi K, Ogawa A, Ikuyama K, Akai Y, Okano M, Kagoshima M, Tsuchida T. Regulation of abdominal adiposity by probiotics (Lactobacillus gasseri SBT2055) in adults with obese tendencies in a randomized controlled trial. Eur J Clin Nutr. 2010 Jun;64(6):636-43. doi: 10.1038/ejcn.2010.19. Epub 2010 Mar 10. PMID: 20216555.

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