By Dr. David Friedman
Probiotics are the latest health buzz, and deservingly so. They are the “good” bacteria in your gut that can help keep your microbiome population in balance. Your gut also contains “bad” bacteria which, unfortunately for some people, outnumber the good. Ideally, the balance of gut flora should be approximately 85 percent good bacteria and 15 percent bad bacteria. When this ratio gets off balance and there’s too much of a certain type of fungus, yeast or bacteria, it can lead to disharmony and disease. The word probiotic broken down actually means “promoting life.” Indeed, our life is dependent on this little bugs.
When probiotics first came on the scene, they were used only as a remedy for diarrhea after taking antibiotics or for people that visited a country with sketchy water. Today, science has discovered many more health benefits including the treatment for Alzheimer’s disease, irritable bowel syndrome, digestive disorders, depression, obesity, eczema, unhealthy gums, urinary and vaginal health problems. How can these little microscopic bugs do so many wonderful things? Because they help to regulate your enzymes, hormones, digestion, mood, and even your quality of sleep! Most health experts agree that the gut is the first place to focus on if you want to optimize your health. This makes sense considering 75% of your immune system lives in your gut.
Your gut also effects your emotions. Have you ever had a gut-wrenching car ride, or a gut instinct about someone, or butterflies in your stomach? Research shows, the gut and the mind communicate with one another. So much so, many scientists have called the gut microbiomes your “second brain.” If you are struggling with depression, constantly feeling stressed out or always seem to be in a bad mood, probiotics may offer a solution. Probiotics also help improve daily bowel movements and reduce inflammation and pain throughout the body. This is welcome news for those taking opiod pain medication because they alter nerve input to the gastrointestinal tract which inhibits peristalsis (movement required for proper elimination.) Opioids also increase the absorption of electrolytes and water (making drier and thus harder poops). These factors lead to constipation and a plethora of related health issues. Probiotics can offer natural pain relief and give needed balance to your digestive system.
You can find probiotics in a variety of foods. The most popular options are yogurt and kefir; however, if you have a dairy allergy or sensitivity, this can cause more harm than good. The good news is, there are many dairy alternatives like almond yogurt, coconut yogurt, and coconut kefir. However, watch out for added sugar in these products because they can create inflammation in the gut. Instead, choose products that are sweetened with stevia, xylitol or coconut sugar. Another great option is fermented foods like sauerkraut, apple cider vinegar, pickles, cultured vegetables, and kombucha. Even with these choices available, it’s still difficult to consume the quantity of probiotics needed from diet alone. Supplements to the rescue!
PROBIOTIC SUPPLEMENTS 101
Shopping for a probiotic supplement can be very frustrating. There are literally hundreds of different strains available. Which is the best choice? How many CFUs (colony forming units) do you look for? Do you take them with food or on an empty stomach? When is the best time of day to take them? Should they be stored in the fridge or at room temperature? First, it’s important to know, 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. Here are a few of the most popular probiotic species and what they are most effective for:
Lactobacillus acidophilus and Bifidobacterium: These are the most commonly sold probiotic strains. You will usually find them in the refrigerated section because they are dairy based. This can be a problem if you are allergic or, like many people, have a sensitivity to dairy. These are a great choice for females that suffer from candida albicans, a fungus that can cause yeast infections. However, you’re much better off getting these probiotic strains from foods like yogurt because, in supplement form, they’re very fragile and have difficulty surviving the acidic environment of the gut. If you do decide to get this probiotic strain, you will need to take a lot of it in the hopes some survive the acidic journey through the stomach.
Lactobacillus Plantarum: This a great probiotic strain if you have digestive issues, especially irritable bowel syndrome. It was first isolated in 1986 by a scientist in Lund Sweden who was researching how to rejuvenate human colon tissue. Studies have consistently shown that L. plantarum is great for counteracting the negative gastrointestinal affects of taking antibiotics.
Saccharomyces Boulardii: A well researched probiotic, this is one of the best choices for diarrhea, and for C. difficile infections (a common, and often stubborn gastrointestinal infection). This strain is also a great option if you suffer from inflammatory bowel disease like crohns and ulcerative colitis. In addition, S. boulardii can help treat other ailments, such as lactose intolerance and vaginal yeast infections.
Lactobacillus casei and Lactobacillus helveticus: Your gut flora can affect areas of the brain involved in mood and emotional health. Double blind studies show these two strains of probiotics are a great choice to help combat anxiety, depression and chronic fatigue syndrome. If you are a nervous person with a chronic upset stomach or diarrhea, this is the probiotic strain for you! Also, preliminary research of L. helveticus shows that it may reduce blood pressure with a similar mechanism to ACE inhibitors.
Bifidobacterium longum: This is one of the first microbiomes that colonize within our bodies at birth. It has been associated with improving lactose tolerance and preventing diarrhea, food allergies, and the proliferation of pathogens. It’s also known to have antioxidant properties as well as the ability to scavenge free radicals. In laboratory mice, B. longum has been shown to reduce anxiety. It can help you sleep better and maintain healthy cholesterol levels. B. longum have also been shown to help people suffering with autoimmunity conditions.
Soil-Based Organisms (SBO): A large group of bacteria and yeasts, including Bacillus strains: B. brevis, B. macerans, B. pumilus, B. polymyxa, B. subtilis. As the name implies, soil-based organisms are bacteria that live in the soil. There, they do for plants what probiotic foods do for humans–break down plant material, produce vitamins, combat pathogens, etc. SBO’s are a great probiotic choice to help support digestion, enzyme production, and maintaining a healthy immune system (especially in older adults). These bacillus strains are the most robust, able to withstand heat, light, and other stressors. This strain of probiotic is also a great option for people suffering with autoimmunity and SIBO (small intestinal bacterial overgrowth).
Lactobacillus reuteri: This is one of the most studied strains of probiotic bacteria, boasting a variety of proven health benefits. From improving your skin and health of your hair, reducing pain, yeast infections, to helping increase your Vitamin D levels. Research also shows it may help lower your cholesterol. Preliminary double blind studies have shown that L. reuteri is highly effective for oral health and allergies.
Bacillus coagulans: This strain has been shown to enhance protein absorption, and thereby indirectly improves recovery after working out at the gym. This probiotic decreases bloating, vomiting, diarrhea, abdominal pain and stool frequency and increased the quality of life in patients with irritable bowel syndrome. Research has shown this strain of probiotic helps reductions in total cholesterol and low-density lipoprotein (LDL), along with increases in beneficial high-density lipoprotein (HDL) It has been successfully used in the treatment of rheumatoid arthritis by improved pain, improved self-assessed disability, and it also reduces CRP (C Reactive Protein) inflammatory levels.
THE NUMBERS GAME: Is more better?
There’s a big numbers game being played when it comes to probiotic supplements. Many retailers want you to believe that the more bacteria count (measured in colony-forming units, or CFUs,) the better the product. Most brands list CFU in the billions, ranging from 5 billion, all the way up to 300 billion! However, it’s still uncertain whether more bacteria are actually better for you. Also, the number of CFUs can be skewed and deceptive, especially when the count is taken before the product is manufactured. After it’s handled, manufactured, bottled, and then shipped in a non temperature controlled truck, the CFU count can greatly diminish. Unfortunately, these products are not tested by any regulatory agency, so there is no assurance that the CFU count is accurate; however, there are a few things you can look for.
When shopping for probiotics, search for a clear “best by” or expiration date on the packaging or “Potency guaranteed until time of expiration.” Some products purchased online may require cold-packing during delivery to your home. Make sure UPS doesn’t leave your package on your front porch in the sun. There are a lot of probiotic nutrition bars on the market. I’m not a fan of this option because heat and moisture in the product can kill the probiotic strains. There is one exception, Soil Based Organisms (SBO.) These strains are naturally resistant to heat and acid environments. Also, because of this, the CFU number you see on an SBO probiotic label is usually accurate. If you choose more delicate strains like Lactobacillus and Bifidobacterium, a massive CFU count is needed to guard against the harsh conditions associated with transportation and storage.
Lastly, search for supplement brands that use third-party labs to test the quantity and potency on their strains. For the best quality, make sure the manufacturer is cGMP certified because this means they’re using General Manufacturing Practices, the highest quality standards in the industry. Most cGMP products proudly display this certification on their label and/or website.
CHILDREN AND PROBIOTICS
One of my favorite sayings is, “As the twig is bent, so grows the tree.” If children are taught to embrace a healthy lifestyle early on, they will grow up to be healthy and strong adults. Probiotic supplements are great for kids and babies—it’s never too early to start. If you are giving probiotics to a baby under two years of age, you need to get specific strains that are better suited for such young microbiomes including: Lactobacillus rhamnosus, casei, paralisei, gasseri, salvarius. And for Bifidobacterium: infantis, bifidum, longum, breve, lactis. For breastfeeding mothers, you can put probiotics on your breast, or heat up formula and put probiotics in it, or wet your finger and dip it in probiotic powder and let your baby suck on your finger.
Understanding the different ways that manufacturers package and deliver probiotic supplements is perhaps the most important factor. What methods are used by the manufacturer to ensure the bacteria remain alive and healthy while being delivered and put on store shelves? Are they able to reach the areas in your gut where they’ll be most effective? A probiotic supplement full of dead bacteria—or bacteria that die in a sea of stomach acid—is a waste of money.
Probiotic supplements aren’t always easily absorbed but the good news is there has been a lot of advances in their delivery systems. You can now find probiotic products that offer controlled-release tablets (or caplets) which keeps the strain from being destroyed by the stomach acids. This makes for a significantly high percentage of bacteria reaching your intestines alive. Because this has become a notable selling point, most companies boast this advance delivery system on their product’s packaging and marketing materials. A company that is sharing details with you explaining the stringent quality control factors and their attention to delivery system is often a reflection of their quality.
STORING YOUR PROBIOTICS
Once upon a time, all probiotics had to be refrigerated during transit and stored in a fridge at the health food store and at your home. New manufacturing and delivery systems have mostly done away with that requirement, but you still need to protect the bacteria from too much exposure to light, heat, and moisture. Avoid probiotics sold in clear glass bottles. Instead, go for the darker, thicker glass bottles or white plastic bottles packaged inside of a box. Blister packs are also a great option as well. At home, always store your supplement in a dark, cool place and away from direct sunlight. Dairy based strains like Lactobacillus acidophilus and Bifidobacterium need to be refrigerated.
If the CFU number is guaranteed at time of manufacturing, but not at the time of expiration, you could be taking a less potent dose of probiotics than you think because potency fades over time. It’s important to look at the expiration date on the probiotic supplement. This is the manufacturer’s promise that the bacteria in the product will remain active and potent—at the levels specified on the label—until that date. Usually the expiration date is based on formulation and stability testing data, which means a company is paying attention to those matters. Be leery of purchasing products that don’t have an expiration date on a product label. Without this information, it’s impossible to know how long the bacteria in the supplement are expected to last. It could be a year, or it could be a week. Or the bacteria may already be DOA (dead on arrival!)—you have no way of knowing.
BEST TIME TO TAKE PROBIOTIC SUPPLEMENTS
Timing is everything, and in the case of probiotics, how and when you take it is the difference between absorbing the “friendly bacteria” and wasting away an entire supplement. If you are obtaining your share of probiotics through food, then there is no exact time frame or situation that it is optimal. Since you are consuming it throughout the day it doesn’t necessarily make a difference. However, if you are taking probiotics in supplement form then you need to take them at optimal times to ensure you receive the maximum bacterial strain.
The common misconception is that the best time to take a probiotic is first thing in the morning and on an empty stomach. Probiotics are living organisms and very much like living organisms they need food, water and warmth to survive and multiply. In the morning there is water in the body, some food and it is warm – however these conditions are not optimal for probiotics simply because there is not enough of anything for the bacterial strains to flourish.
The absolute best time to take probiotics is alongside your meal. Right before or just after the meal is best for getting the most out of our probiotics. The journey through your digestive tract is a long and treacherous one. For probiotics, their biggest danger is the powerful acids in the digestive system meant to break down and disintegrate the materials that travels through its passage. If enough acid overcomes the enteric coating of a probiotic capsule it could kill the delicate strains and render your supplement completely useless. By consuming your probiotic with food you provide a buffering system for the supplement and ensure its safe passage through the digestive tract. Aside from protection, food also provides the friendly bacteria in your probiotic the proper food and nourishment to ensure it survives, grows and multiplies in your gut.
Probiotics offer amazing health benefits and should be part of your daily regime. Make sure you’re getting the best probiotic supplement available by focusing on the expiration date, delivery system, manufacturing standards and the specific strain.
* 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.
* Oggioni, Marco Rinaldo, et al. “Recurrent Septicemia in an Immunocompromised Patient Due to Probiotic Strains of Bacillus Subtilis.” Journal of Clinical Microbiology 36.1 (1998): 325–326.
* Mckenney, P.T., Driks, A., Eichenberger, P. “The Bacillus subtilis endospore: assembly and functions of the multilayered coat.” Nat Rev Microbiol. (2013): 33-44.
* Latorre, J.D., Hernandez-velasco, X., Wolfenden, R.E., et al. “Evaluation and Selection of Bacillus Species Based on Enzyme Production, Antimicrobial Activity, and Biofilm Synthesis as Direct-Fed Microbial Candidates for Poultry.” Front Vet Sci. (2016): 95.
* Lefevre, Marie, et al. “Probiotic Strain Bacillus Subtilis CU1 Stimulates Immune System of Elderly during Common Infectious Disease Period: A Randomized, Double-Blind Placebo-Controlled Study.” Immunity & Ageing : (2015): 24.
* Br J Nutr. 2012 May;107(10):1505-13. doi: 10.1017/S0007114511004703. Epub 2011 Nov 9.
* Cholesterol-lowering efficacy of a microencapsulated bile salt hydrolase-active Lactobacillus reuteri NCIMB 30242 yoghurt formulation in hypercholesterolaemic adults.
* Microbiol Immunol. 2009 Sep;53(9):487-95. doi: 10.1111/j.1348-0421.2009.00154.x.
*cFarland, L. V. Evidence-based review of probiotics for antibiotic-associated diarrhea and Clostridium difficile infections. Anaerobe/Clinical microbiology 15 (2009) 274–280.
*Bouma, G., Strober, W. The immunological and genetic basis of inflammatory bowel disease. Nat Rev Immunol. 2003;3:521–533.
* Saccharomyces boulardii Inhibits Inflammatory Bowel Disease by Trapping T Cells in Mesenteric Lymph Nodes Gastroenterology. December 2006 Volume 131, Issue 6, Pages 1812–1825
* Mohan JC, Arora R, Khalilullah M. Preliminary observations on effect of Lactobacillus sporogenes on serum lipid levels in hypercholesterolemic patients. Indian J Med Res. 1990 Dec;92:431-2.
* Gut Pathogens December 2009,1:6 A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome.
* Michaël Messaoudi, et al. Gut Microbes Volume 2, 2011 – Issue 4 Beneficial psychological effects of a probiotic formulation
* David R Mandel et al. Bacillus coagulans: a viable adjunct therapy for relieving symptoms of rheumatoid arthritis according to a randomized, controlled trial BMC Complement Altern Med. 2010; 10: 1.
* Ralf Jager et al. Probiotic Bacillus coagulans GBI-30, 6086 reduces exercise-induced muscle damage and increases recovery PeerJ. 2016; 4: e2276.
* Fedorak, Dr. Richard, Digestive Disease Week 2003. http://www.crohns.net/Miva/education/articles/fedorak_DDW.shtml
* Niedzielin K, Kordecki H, Birkenfeld B.A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome.
* Nguyen, T.D.T. et. al., Characterization of Lactobacillus plantarum PH04, a potential probiotic bacterium with cholesterol-lowering effects. International Journal of Food Microbiology. Volume 113, Issue 3, 15 February 2007, Pages 358-361.
* Eur J Gastroenterol Hepatol. 2001 Oct;13(10):11437