Our gastrointestinal tract, that 30-foot tube inside of us does a LOT more than just break down food. Impacting much more than digestion, the health of our largest organ is considered the cornerstone of overall health. It makes up about 70% of our immune system and influences our mood, inflammation levels, the foods we crave —and even how much we weigh! Recognizing the important role of good bacteria in gut health, many people take probiotics to improve specific health conditions or for general health.
But, how do you know which probiotic is right for you? If you need a probiotic for a specific health condition, you should consult your licensed health care practitioner. They can recommend the specific strain and dosage which have been clinically researched for your needs. But, if you are looking for a general all-purpose probiotic for prevention or to resolve digestive discomforts (bloating, indigestion, changes in regularity), the choices are easier. However, anyone using probiotics needs to be an informed consumer.
Buyer Beware! According to research by ConsumerLab.com, many products on the market simply do not contain what is advertised on the label. In 2009, the majority (85%) of probiotics they selected for testing did not contain the listed amounts of live organisms. It was later learned that improper shipping and warehousing may have been at least partly to blame for their testing failure. When ConsumerLab.com repeated this test in 2012, the results were better. But, 17% of the products still failed to meet their label claim. And in a research study of 16 lactobacilli acidophilus products, 11 of 16 (69%) products were contaminated and only four (25%) products actually contained any Lactobacillus acidophilus. The take away? Use caution in selecting a probiotic or you could be buying dead microbes or different microbes than you had expected, possibly wasting your money. So…
How do select a quality probiotic product? Who should you trust?
Many healthcare providers rely on the recommendations of the International Scientific Association for Probiotics and Prebiotics, a non-profit organization dedicated to promoting the science behind probiotics and prebiotics. ISAPP collaborates with related organizations* on probiotic preparation and usage guidelines. In short, they do the research for you and have published a consumer’s guide for selecting a quality probiotic product. Here are some of the highlights.
A Consumer Guide for Making Smart Probiotic Choices
Adapted from the International Scientific Association for Probiotics and Prebiotics
- Not all probiotics are created equal. Strain identification matters.
A probiotic is defined by its genus (e.g. Lactobacillus), species (e.g. Acidophilus) and strain designation (often a combination of letters or numbers, such as NCFM). The concept of a bacterial “strain” is similar to the breed of a dog – all dogs are the same genus and species, but different breeds of dogs have different attributes and different breeds are good for different tasks. I.e., would you select a team of dachshunds for dog sledding? It would be incredibly cute, but not so effective. Just as Dachshunds and Siberian Huskies are the same genus and species, the breed makes all the difference.
See what I mean?!
Similarly, different strains of even the same probiotic species may be different from each other. You can’t assume they will have the same effects. In fact, only a handful of probiotic strains have been clinically shown to support human health. And, products that contain strains without scientifically established health benefits may not be health-promoting bacteria at all! The probiotic names may be long and sound complicated, but are important to linking a specific probiotic strain to it’s published scientific literature.
- But —don’t be confused by trademarked (™) or registered trademark (®) names for strains.
Manufacturers often use a consumer-friendly name for the strain in their product. These are for marketing and branding purposes. These are not scientific names and don’t reflect product quality.
- Probiotics must be tested in humans and shown to have health benefits.
What do all the claims mean? Most probiotics are sold as dietary supplements or ingredients in foods. This means their labels can’t legally declare that the probiotic can cure, treat or prevent disease. But, while claims which connect the product to health are allowed, any claim made on a product, no matter how general, should be truthful and backed up by research.“Clinically proven” You might have to do some homework. Product claims of health benefits must be based on sound research done on the particular probiotic. The product should contain the specific strain(s) of bacteria in the same quantity used in published research. The studies should be performed in humans and published in peer-reviewed, scientific journals. Check product websites to see study results. Your pharmacist or healthcare provider should be able to help you sort through the scientific language.Just because it says “probiotic” doesn’t mean it is a probiotic. Some products labeled “probiotic” do not have clinically validated strains or levels in the product.
- Choose a product at the right quantity
What is the minimum CFU I should look for? Probiotics are measured in colony forming units or “CFU”. CFU is the measure of live microbes in a probiotic. The CFU amount should be the same as the amount shown to be effective in clinical studies. More CFUs does not necessarily mean better.
One size does not fit all. Different probiotics are effective at different levels. There is no single universal optimal CFU count. In the scientific literature, you’ll find documented health benefits for products with CFU counts ranging from as little as 50 million to more than 1 trillion CFU/day. The proper dose depends on the strain.
- Pick a product from a trusted manufacturer. Look for a GMP-certified manufacturer who will guarantee its probiotic product has the same genetically verified strain(s) and potency as what was used in clinical studies. They will also guarantee the CFU count until the expiration date, not just at the time it was manufactured.Here’s what the label should tell you:
* Strain: What probiotic is inside?
* CFU (Colony Forming Units): How many live microorganisms are in a serving?
* Expiration: When does it expire? Packaging should utilize materials, such as amber-colored glass, to protect the live microbes from light, moisture and oxygen. This helps ensure that the level of live bacteria is at least as much as the amount on the label all the way through the “best by” or expiration date. Pass on a probiotic if the label says “viable at time of manufacture.” Everything could be dead when you buy it.
* Suggested serving size: How much do I take?
* Health benefits: What can this product do for me?
* Proper storage conditions: Where do I keep it to ensure maximum survival of the probiotic?
* Corporate contact information: Who makes this product? Where to do I go for more information?
Don’t forget to ask your integrative healthcare professionals. They will be able to share brand and dosage recommendations based on what they have seen work with their patients. Most likely they will steer you towards a multi-strain product as the research is trending heavily in the direction of diversity for general maintenance rather than single strain products.
And finally, gut health involves much more than buying a carefully selected supplement! Stay tuned for future posts as I cover ways to improve gut health through diet. We’ll explore food sources of probiotics and the prebiotics to feed them.
*the American Gastroenterological Association, World Gastroenterology Organisation, National Academies of Sciences, International Life Sciences Institute, Harvard Division of Nutrition, Food Chemicals Codex and the New York Academy of Sciences)
Perdigon G, Fuller R, Raya R. Lactic acid bacteria and their effect on the immune system. Curr Issues Intest Microbiol. 2001;2:27-42.
Microbiologic characteristics of Lactobacillus products used for colonization of the vagina. Hughes VL1, Hillier SL. Obstet Gynecol. 1990 Feb;75(2):244-8.
Probiotics: A Consumer Guide for Making Smart Choice
The International Scientific Association for Probiotics and Prebiotics