Walk into any grocery store, and you will likely find more than a few “probiotic” products brimming with so-called beneficial bacteria that are supposed to treat everything from constipation to obesity to depression. In addition to foods traditionally prepared with live bacterial cultures (such as yogurt and other fermented dairy products), consumers can now purchase probiotic capsules and pills, fruit juices, cereals, sausages, cookies, candy, granola bars and pet food. Indeed, the popularity of probiotics has grown so much in recent years that manufacturers have even added the microorganisms to cosmetics and mattresses.
The truth is we need probiotics. We couldn’t survive without them. There are about 10 trillion cells that make up our human body, everything from skin, to hair, to our muscles and organs, however there are over 100 trillion bacteria and over a 1000 different species that make up the digestive tract alone. Bacteria outnumber our human cells 10 - 1. We essentially are more bacteria than we are human.
Probiotics are just as important as any other structure in the body, like your kidneys, or spleen, or heart. They are essential to our survival. They play a major role. Everything from digesting the food we eat to protecting us from outside invaders and the toxic world we live in. And so much more. So thinking that just by eating yogurt, which may only contain 2 different strains of bacteria plus a lot of sugar, is helping you might want to rethink this. I’m not against yogurt. Don’t hear me wrong. But as you can do the math, there is more missing than you are consuming. But wait there’s more to this story...
So in this article we’ll discuss some of the most popular myths surrounding probiotics and I’ll give you some tips on how to choose the right probiotic for you.
Myth #1: Quantity over Quality: The Billions Myth (109)
In today’s society we are often bombarded by the marketing message that more is better. When it comes to probiotics however, this can cause us to pay inadequate attention to the quality of the probiotic strains, and the research behind them. In fact the quality of the strain or combination of strains in a probiotic supplement should be the first thing to consider, over and above the number of billions. There is little point taking a really high strength probiotic if it does not survive well at room temperature and the challenge of stomach acid and bile. Once it has made it into the gut it must be able to adhere to the gut wall in order to colonize and flourish, and it should be able to secrete antimicrobial substances to ward off the overgrowth of other pathogenic (bad) bacteria in the gut. These are all basic requirements for a high quality probiotic, before we even consider the strength or the number of billions. It would be misguided to jump in for the high billions probiotic and side step these crucial quality considerations.
Which leads us to…
Myth #2: The more strains the better!
You’ve probably heard of the bacteria genus of Lactobacillus or the genus Bifidobacterium. Within these two genus there are more likely even more species that you have heard of like Lactobacillus Acidophilus. Different species have different roles and functions within the body.
For example the most researched probiotic for diarrhea is Saccharomyces boulardii - this is a single strain. Lactobacillus and Bifidobacterium species are well studied and have shown to help those suffering with IBS and SIBO (which causes diarrhea, gas, bloating, constipation, brain fog, depression, weight struggles, and blood sugar dysregulation).
Due to the diverse nature of the gut microflora it can be instinctive to assume that a probiotic containing many different strains is best. However, the research simply does not support this theory.
There are clinical trials that test single strains, or two-strain formulas, and which demonstrate excellent health benefits. For instance Saccharomyces boulardii is the most researched probiotic for diarrhea in adults1, and it is a single strain.
Bifidobacterium lactis BB-12® is the most documented of all the Bifidobacteria strains, and clinical trials show it is particularly helpful for symptoms of constipation2. Again, this is only a single strain!
Myth #3: A probiotic needs an enteric coating to survive.
A probiotic should have a special capsule or be encapsulated in an enteric coating is simply marketing.
None of the 10 most researched probiotics worldwide use, or need, extras like enteric coating to survive stomach acidity.
While enteric-coating capsules can certainly improve the chances that they’ll survive through stomach acid and make it into the small intestines, the probiotic’s journey is not yet complete. Once in the small intestine it still has to face bile salts and pancreatic enzymes that kill off bacteria. They still will not make it through the almost 30 feet of small intestine to get to the large intestine where they are supposed to function. If your probiotic needs a special enteric coating, special capsule, seaweed coating or some other technology in order to survive digestion, then it will most likely be too weak to colonize in the gut – a/k/a compete with the other 100 trillion bacteria already residing in your gut.
A better approach is to find a probiotic that naturally survives the gastric system, not one that has to be engineered to survive the stomach.
Myth #4: You can get all the probiotics you need from your diet.
False. Although fermented foods can be excellent prebiotics and can provide nutritious, predigested food that feeds your gut bacteria, they don’t create lasting ecological change in the gut and do not deliver living probiotic cells to the large intestine. If you can tolerate fermented foods, they are a great source of nutrients and should be consumed, assuming they aren’t yogurts and drinks loaded with sugar. They do not however, replace an effective, gastric surviving, DNA verified probiotic.
While fermented foods such as kefir & yoghurt are good for you, they can’t provide specific health benefits like a probiotic supplement can. To look after the gut microbiota, it’s helpful to increase probiotic and prebiotic consumption to boost overall friendly bacteria counts, and to decrease excess fast food, sugar and alcohol consumption which work negatively against the microbial balance.
Myth #5: Probiotics have to be refrigerated.
Of the 10 most researched probiotic supplements worldwide, only 1 requires refrigeration. While some good probiotics may be kept in the fridge, this storage method does not necessarily equate to superior quality. There are a few reasons why refrigeration is less of a requirement these days. These include improvements in freeze drying techniques and discovery of strains which are naturally more robust within themselves.
Probiotics can be deemed to be the ‘best’ by a number of different criteria, but the most impressive standard of quality is considered to be a clinical trial conducted using gold standard techniques. It is quite a challenge to sift through all the available (and ever growing) research and reliably to pinpoint the most researched probiotics in the world, but the top 10 are certainly amongst the following strains and supplements: L. rhamnosus GG3, S. boulardii4, L. plantarum 299v5, B. infantis 356246, L. reuteri DSM 179387, B. lactis BB-12®8, L. acidophilus NCFM®8, L. acidophilus La-58; also the combination of L. reuteri RC-14® and L. rhamnosus GR-1®8, and the probiotic formulation known as VSL#39.
Myth #6: The Cure-All Myth: All probiotics do the same thing.
In a healthy state there is a huge diversity of microorganisms in our body. There are similarities between some microorganisms but they have subtle, and often significant, differences in how they help with various aspects of our health. As a general rule of thumb, Lactobacilli tend to live in the small intestine and their properties include the secretion of digestive enzymes to help break down food, whereas Bifidobacteria tend to live in the large intestine and amongst other benefits, are important to ensure we have regular bowel movements. However, within each of these genus of bacteria there are many species, and within each species there are many strains; these strains have been shown to have different effects on the body.
For example, in comparing the properties of two different strains from the same species: L. rhamnosus, it soon becomes apparent that they have totally different attributes. L. rhamnosus Rosell-11 has been shown in numerous clinical trials to stabilize gut health when taking antibiotics, and to reduce the risk of antibiotic-associated diarrhoea10. L. rhamnosus GR-1® on the other hand has not been shown to directly aid digestive health; instead it has been shown to colonize in the vaginal tract11 and to help maintain balance in the microflora of the intimate area, especially in conditions such as thrush12, cystitis13 and bacterial vaginosis14.
When it comes to probiotics, research shows us time and time again, that it is certainly not a case of ‘one-size-fits-all’.
McFarland (2010) Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol; 16, 18: 2202-22
Eskesen et al. (2015) Effect of the probiotic strain Bifidobacterium animalis subsp. lactis, BB-12®, on defecation frequency in healthy subjects with low defecation frequency and abdominal discomfort: a randomised, double-blind, placebo-controlled, parallel-group trial. Br J Nutr; 114, 10: 1638-46.
Cruchet et al. (2015) The use of probiotics in pediatric gastroenterology: a review of the literature and recommendations by Latin-American experts. Paediatr Drugs; 17, 3: 199-216.
McFarland (2010) Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol; 16, 18: 2202-22.
Ducrotté et al. (2012) Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol; 18, 30: 4012-8.
Whorwell et al. (2006) Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol; 101, 7: 1581-90.
Schreck Bird et al. (2016) Probiotics for the Treatment of Infantile Colic: A Systematic Review. J Pharm Pract pii: 0897190016634516. [Epub ahead of print]
Yuan Kun Lee et al. (2009) Handbook of Probiotics and Prebiotics, 2nd Edition Wiley: New Jersey
Shen et al. (2014) Effect of probiotics on inducing remission and maintaining therapy in ulcerative colitis, Crohn’s disease, and pouchitis: meta-analysis of randomized controlled trials. Inflamm Bowel Dis; 20, 1: 21-35.
Foster et al. (2011) A comprehensive post-market review of studies on a probiotic product containing Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011. Benef Microbes; 2, 4: 319-34.
Reid et al. (2001) Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol; 30, 1: 49-52.
Martinez et al. (2009) Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol; 48, 3: 269-74.
Beerepoot et al. (2012) Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med; 172, 9: 704-12.
Anukam et al. (2006) Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Microbes Infect; 8, 6: 1450-4.