Best Probiotic Supplements: What to Look For
When you are concerned with your health, you need the best probiotic product possible. You need a blend of probiotic microflora you can count on to be truly effective, and a brand you can trust.
But how can you know which probiotic supplements are the best? The challenge lies in choosing which of the many options are right for you.
What's Really Important? 7 Top Criteria
In the debate about which probiotic products offer optimal health benefits, the subject of "probiotic survivability" is rarely raised. Even the most diligent consumer is led to believe that the goal for good health lies in ingesting sheer numbers of probiotic bacteria. The media would have us believe that getting 1 billion CFUs (Colony Forming Units) is ideal.
The fact is, probiotics differ significantly in terms of CFUs because of a lack of survivability in many common probiotic strains. Most have short shelf life and require constant climate control. And many cannot withstand the harsh acidic environment of the stomach and intestinal tract. 1
Finding an effective probiotic supplement that provides both shelf life and viability is the key to making a good probiotic choice.
You’ll want to find a probiotic that meets all of the following criteria:
1. Multi-strain, broad-spectrum formula
The human gut is a complex mix of 10,000 different types of bacteria, with the vast majority being commensal or "helpful" bacteria. 2
These bacteria co-exist with fungi and yeasts in symbiotic communities which help to maintain digestive health. When the delicate balance of intestinal microbiota is altered significantly, functional digestive decline can occur.
Since the microbiota within the digestive tract is so varied, experts suggest a probiotic formula with the most diversity, one which reflects the healthy balance of the digestive tract.
Currently, some of the most common bacterial strains found in products include:
Lactobacillus: acidophilus, L. casei, L. fermentum, L. gasseri, L. jonsonii, L. lactis, L. paracasei, L. plantarum, L. reuteri, L. rhamnosus, L. salivarius.
Bifidobacterium: bifidum, B. breve, B. lactis, B. longum, B. animalis, B. infantis.
Soil-Based Organisms (SBO): A large group of bacteria and yeasts, including Bacillus strains: B. brevis, B. macerans, B. pumilus, B. polymyxa, B. subtilis.
Yeast: Saccharomyces cerevisiae (boulardii).
Research has demonstrated that probiotic strains within the same genus or group (such as Bacillus, Lactobacillus, Bifidobacterium, etc.) provide different benefits in the gut. This also applies to yeasts and soil-based organisms which provide specific benefits to intestinal health. Thus, in order to bring balance to the "good" and "bad" bacteria count, a multi-strain probiotic formula reflecting a diversity in both number of species and number of genera (groups) is recommended.
Naturally-Derived, Based on the Primary Bacteria Found in the Healthy Gut
A naturally-derived matrix of probiotics can mimic the natural exposure to healthy bacteria that help develop a healthy gut.
2. Live, shelf stable bacteria
In order to work their magic in the small intestine, probiotics must survive storage and transportation to the end user. Temperature, humidity, oxygen and moisture can have a significant impact on the survival of probiotic bacteria, with some probiotics requiring refrigeration within a specific temperature range to ensure survival. 1
When shopping for probiotics, look for a clear "best by" or expiration date on packaging. Some products purchased online may require cold-packing during delivery to your home. Probiotic nutrition bars may or may not be a good source of probiotics, as moisture in the product may kill the probiotic bacteria. 3
Foil blister packs are one way to increase probiotic viability. Another approach is the use of SBO probiotic strains that can withstand any type of environmental change – retaining their potency through the harsh conditions associated with transportation and storage. These SBO bacteria are equipped with natural protection against various temperatures and do not require refrigeration.
3. Viable species
The issue of "survivability" in the gut is an important one – probiotics will spend roughly four hours in the harsh environment of the stomach before traveling to the intestines where they are needed! Certain probiotic species, such as Lactobacillus acidophilus, L. casei, and Bifidobacterium bifidum, are too fragile to survive in the acidic gut as they have no protection against its acidic environment. 1
The choices in probiotics designed to survive and thrive this journey include those that contain naturally resilient strains of microbiota, and those which use manufactured delivery technologies like enteric coatings, delayed-release formulas, and "beadlet" formulations.
One such example, enteric coated pills, have been a source of controversy. Industry experts believe the encapsulation process itself destroys probiotic bacteria. Phthalates, a form of known carcinogen, have also been discovered in some enteric coatings. 4
Other forms of delivery technologies include delayed-release gut-protective coatings and "probiotic pearls" or "beads". These technologies attempt to imitate nature by enclosing live probiotic bacteria in a small beadlet.
However, nature provides its own version of protected bacteria in the form of spore-forming species such as those found in the Bacillus genus, a form of bacteria found in some traditional Asian fermented dishes such as natto and kimchi. Much like a seed, these bacteria form their own natural protective layer and release when they enter a healthy environment such as the lower gut. Prescript-Assist is one probiotic which utilizes this natural form of protection.
It’s also important to know that some brands of probiotics use coatings (like whey) which could trigger milk allergy reaction; others use synthetic chemicals or a seaweed derivative (high in cancer-causing iodine). (Also, Lactobacillus is often cultured in a milk-derived substance, so even if a probiotic product is non-dairy, the bacteria may contain remnants of milk protein.)
When considering coated probiotics, find a manufacturer you trust. If you have concerns with synthetic additives or allergies, be sure to contact the manufacturer to determine the risk. Also, avoid products using whey coatings or Lactobacillus if you have a history of milk allergies or sensitivity.
4. Potential to colonize
When probiotic bacteria reach the lower intestine, there’s another test. How long will they last there? Will they survive long enough to provide a benefit? Research shows that Lactobacillus and Bifidobacterium do not take up residence in the gut and are transient, so they have a subtle short-term effect on the intestine before being shed in feces. 5
Spore-forming organisms, however, latch onto the intestinal wall and start establishing a community immediately. Studies (human and mouse) show that these probiotic bacteria continue to re-populate the intestine for at least one month. This provides ample time to improve intestinal health.
5. Contains prebiotics
A prebiotic is a natural nutrient that supports the proliferation of probiotic bacteria. This creates a "symbiotic" relationship that supports delivery (and proliferation) of viable probiotic bacteria in the lower intestine.
Many probiotic supplements contain a prebiotic, but not all. The presence of a prebiotic provides a source of fuel for the probiotics increasing the chances of successful propagation. Read the product label carefully to see if a prebiotic is listed.
6. Free of flow agents and synthetic coatings, dairy-free, and gluten-free
The highest quality probiotic products are free of "flow agents" used in manufacturing, like magnesium stearate, titanium dioxide, preservatives, colorings or artificial ingredients. Synthetic coatings are unnecessary to ensure delivery to the proper area of the digestive tract.
Additionally, seek probiotics that are dairy-free and gluten-free to ensure safety in people with allergies or sensitivities.
7. Demonstrated efficacy and safety
A trusted brand can provide results of human clinical trials of their probiotic products. If a manufacturer does not have this proof of efficacy and safety, look for a product that does. Published, peer-reviewed clinical studies are the gold standard in seeking the best probiotic supplements.
Is CFU Count Important?
The CFU (colony forming unit) is the standard measure of live cells in the probiotic product, but it is not the best indication of the probiotic’s ability to support healthy digestive function.
Firstly, the CFU count on a product label is often misleading. Many probiotic products, upon testing, have been found to have lower CFU counts than those indicated on the label. These products are not tested by any regulatory agency, so there is no assurance that the CFU count is accurate.
What’s also important to understand is that CFU count has become a point of note in probiotic labeling simply because most common probiotic microflora are unstable. For common lactic-acid based (LAB) microflora such as L. acidophilus and B. bifidum a steady decline in numbers of viable microoranisms ensues immediately after the probiotics are manufactured. 1 CFU count was introduced as a way to monitor the ongoing loss of viable species in such products, yet what is not commonly understood is that certain forms of probiotic microflora do not demonstrate this same instability.
For most soil-based probiotics which are naturally resistant to heat and acid environments — a.k.a. "inherently viable" — the notion of CFU makes no sense. It is not necessary to pack these probiotics with massive numbers of organisms in order to guard against their loss, because they are not sensitive to manufacture, transit or use.
When choosing a probiotic, consider the types of species listed on the ingredient label. For Lactobacillus and Bifidobacterium, CFU count is applicable, yet demonstrates that a massive number of species has been front-loaded into the product to guard against inevitable loss. For soil-based products such as those based on the Bacillus genus and others, look to studies and other factors when comparing brands.
Consult With a Trusted Health Care Professional
Even the best probiotics supplements need to be taken with care. Before taking a probiotic supplement, talk to your health care practitioner – especially if you have a compromised immune system or any major illness. Read the product’s "Warning" and "Other Information" and pay attention to symptoms or side effects.
Buy a brand you trust, and evaluate each product against the seven concerns mentioned in this article. Many excellent products exist on the market, and you may elect to choose more than one to meet your full needs! Understand how to identify the variety of different types of probiotics, the highest quality options, and what will work best for your concerns.
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1. Kailasapathy, K., & Chin, J. (2000). Survival and therapeutic potential of probiotic organisms with reference to Lactobacillus acidophilus and Bifidobacterium spp. Immunology and Cell Biology, 78(1), 80–8. doi:10.1046/j.1440-1711.2000.00886. Available at: http://www.nature.com/icb/journal/v78/n1/full/icb200012a.html
2. "NIH Human Microbiome Project Defines Normal Bacterial Makeup of the Body." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 06 Aug. 2015. Available at: http://www.nih.gov/news/health/jun2012/nhgri-13.htm
3. Growing Potential." Nutritional Outlook. N.p., n.d. Web. 06 Aug. 2015. Available at: http://www.nutritionaloutlook.com/article/growing-potential
4. Zerbe, Leah. Plastic in Medications Could Make You Sick. Prevention. Available at: http://www.prevention.com/health/healthy-living/dangers-pthalates-pill-coating
5. McNulty, N. P., Yatsunenko, T., Hsiao, A., Faith, J. J., Muegge, B. D., Goodman, A. L., … Gordon, J. I. (2011). The Impact of a Consortium of Fermented Milk Strains on the Gut Microbiome of Gnotobiotic Mice and Monozygotic Twins. Science Translational Medicine, 3(106), 106ra106–106ra106. doi:10.1126/scitranslmed.3002701. Available at: http://stm.sciencemag.org/content/3/106/106ra106