How Do I Choose a Probiotic?

February 11, 2013
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We know now that probiotics are good for us. But with so many to choose from, how do we choose one that’s right for us? Not all probiotics are created equal; different varieties of bacterial strains have different benefits, in addition to differing potencies, routes of ingestion, manufacturing methods and so on. Read on to learn how to choose a probiotic that’s right for you.

First, identify why you need probiotics. It may be to counteract a course of antibiotics, to support digestion, to treat a yeast infection or simply to boost immunity. While many products are formulated to suit a particular need, others are general in their labeling. Here are a few things to keep in mind when looking for a probiotic that suits your needs.

While taking antibiotics
Antibiotics are good at their job of wiping out invasive bacteria. The problem is that they are also good at killing beneficial bacteria, setting the stage for gastric distress, diarrhea and possible secondary infection—making it critical to take probiotics concurrently. Note that you should always take antibiotics and probiotics on opposite schedules so their effects do not counterbalance each other (i.e. take probiotics at least 2 hours away from antibiotics).

While on antibiotics, take a higher-potency probiotic (20-100 billion) to replenish gut flora, and continue them for a month or more after your course. For this purpose I recommend Renew Life’s Ultimate Flora Critical Care,Nature’s Way Primadophilus Optima, Pharmaca’s Ultimate Probiotic Blend and Pharmax High Intensity products.

Yeast and women’s balance
Probiotics are very effective in balancing vaginal flora, which helps guard against infection and prevent overgrowth of candida. Suppositories offer a direct method to assist vaginal flora—be sure it has at least a billion lactobacillus to support vaginal flora. Taking oral probiotics at the same time can offer maximum coverage. Try Jarrow Formulas’ Fem-Dophilus or Vitanica’s FemEcology. Both of these products are formulated for vaginal flora balance and can be used as suppositories as well.

Probiotics for children
Probiotics are extremely important for developing digestive tracts and supporting immunity. Kid-specific products are formulated to make them appealing for little ones. Try Jarrow Formulas’ Yum-Yum Dophilus or Nature’s Way’s Primadophilus Kids.

Potency
Potency is measured in colony forming units (CFUs). A good first step is to ensure you choose a product that gives a “good until” date to ensure potency until a certain date. (Some manufacturers only stamp their CFUs at the time of manufacture, e.g. “1 billion active L. acidophilus and B. bifidum at the time of manufacture.”) Because probiotics are live organisms at the time of manufacture, over time you can expect a slow die-off of bacteria, which ultimately renders the probiotic useless. This happens much faster if the product is improperly stored.

Potency varies widely in probiotic supplements, generally between 1 and 100 billion CFUs. Currently there are no standardizations for dosing and potency with probiotics. You may need a period of adjustment to identify what potency is optimal for you, but here are some general guidelines to help you start.

  • For mild digestion problems (gas, bloating, diarrhea) try starting with a lower dose (5-10 billion CFUs) and working up.
  • For more severe digestion issues (chronic diarrhea, gas, bloating and infections), you may want to try taking a lower potency every other day and working your way up to a much higher potency (since there can be gas and bloating associated with probiotics colonizing in the gut).
  • For bowel regularity, try New Chapter’s Probiotic GI Tract.
  • For general intestinal maintenance, try taking 1-2 billion CFUs per day, as in Enzymatic Therapy’s Acidophilus Pearls. Many people choose to take a much higher maintenance dose because they have found that it gives them optimal digestion and immunity. A popular product for daily use is Jarrow Formulas’ Jarro-Dophilus EPS,which contains 5 billion per dose and does not require refrigeration.

In addition, probiotic formulas are often formulated with added prebiotics—non-digestible food that feeds probiotics and promotes healthy flora. Examples of prebiotics include FOS and inulin. Try Jarrow Formulas’ Jarro-Dophilus + FOS or Pharmaca’s Acidophilus and Bifidus.

Other considerations

Allergens

Since many probiotics are grown in a culture that contains dairy, people who are completely lactose intolerant must look for dairy-free formulas. There may also be traces of gluten in some products, so be sure to check the label or ask a qualified health practitioner for a gluten-free option. A few allergen-free products to try include Pharmax HLC, Jarrow Formulas’ Allergen-Free Jarro-dophilus or Thorne Research’s FloraMend.

Storage

Many probiotics require refrigeration to maintain potency, which can be inconvenient—especially for travel—but there are several good probiotics that do not require refrigeration. Try Jarrow Formulas’ Jarro-Dophilus EPS, Essential Formulas’ Probiotics 12 Plus Original Formula or Enzymatic Therapy’s Pearls. Be sure to follow proper storage of your probiotic, paying attention to moisture, light and temperature.

Delivery methods

There are a variety of delivery methods for probiotics, including liquids, powders (great for infants!), capsules, chewables and suppositories. Fermented foods are also a terrific source of probiotics, including kefir, yogurt, sauerkraut, anything pickled, miso, tempeh and soy sauce. Kombucha is a popular fermented tea that is a great source of probiotics.

Directions

Be sure to read directions thoroughly! Products can differ based on whether or not they should be taken on an empty stomach.

Side effects

Probiotics are considered generally safe and well tolerated, and serious side effects are fairly uncommon. Possible side effects include gas, bloating and tenderness in the gut (either to the touch or with motion) and possible diarrhea or constipation. Because these symptoms occur while the bacteria are colonizing in the gut, they tend to become less pronounced with ongoing use. There have been rare reports of infection occurring in the severely ill or immune-compromised.

There is no evidence that higher doses of probiotics are unsafe (even though they may be more expensive and unnecessary for some). When in question, start lower and work your way up. Back off on potency if you are experiencing uncomfortable symptoms from the probiotics, but don’t give up! Speak with a qualified health practitioner if you have concerns with any side effects from probiotics colonizing.

Trusted manufacturers

Perhaps the most important aspect in choosing your probiotic is purchasing from trusted manufacturers with good manufacturing practices and quality control! These brands should have research available to demonstrate the effectiveness of their products, including proof of potency and ability to survive the environment of stomach acids and bile salts. Special manufacturing techniques are required to ensure the probiotics make it to their destination for colonization (i.e. small or large intestine). Examples of these techniques include enteric coating and “beadlet” technology. A few examples of trusted manufacturers include Pharmax, Metagenics, Pharmaca, Renew Life, New Chapter, Jarrow, Udo’s and MegaFood.

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