If you ever visited the local health stores or organic/natural markets, you probably noticed the probiotic products section. Maybe you read about it online or hear about it from a friend. This is a growing market and unfortunatly, is unregulated by any agency (including the FDA). Most probiotic we found, do not even guarantee live bacteria in them! They just specify how much was put in the bottle at time of manufacturing. Before we get in to how can pick a good probiotic support for yourself, the first question to ask is what are the probiotics and are they essential to our health?
Probiotic and Our Health
It is estimated that we have over 500 different species of bacteria in our gastrointestinal tract with an average weight of 2 to 7 pounds. The amount of bacteria is so large that all together, they are considered by some researchers to be as big as your liver. Have you ever thought about the role of these bacteria in your body? These bacteria is living within you for a reason. According to studies, These beneficial bacteria have an important role in keeping us healthy. Among the many functions of these bacteria are the following: [sources 1,2]
Stimulate your immune system.
Fight other harmful bacteria and prevent them from flourishing and causing infection (for example E. Coli bacteria).
Assist with the breakdown and absorption of nutrients from food.
Create the (so needed) vitamins B and K.
Reduce risk of certain cancers.
Regulate the function of the immune system (for example to prevent allergic reaction or the chronic inflammation in the gut).
Probiotics was found to be beneficial for the protective layer of Mucin in the gut, leading to reduction in the immune reaction due to food allergy or damage from bacteria. These bacteria increase the expression of the genes that activate the produce the gut mucin.
We have a symbiotic relationship with our bacteria. We provide them with food and a safe, warm, and moist place to live and thrive. In return, they help us maintain healthy function. There are several factors that can cause damage to our beneficial bacteria, among them are antibiotics, pathogenic (harmful) bacteria, or even stress.  For that reason, it is essential to supplement our body with healthy bacteria. Unfortunately, not all supplements have the same quality and some might even be harmful for you.
The Problem with Most Probiotic Supplements
A study published in the Public Health Nutrition magazine, examined 52 probiotic supplements to determine the quality and amounts of viable bacteria in each found that many of the claims posted on the supplements were misleading. Among the 52 supplements, only five accurately described their bacterial content. Most of the products did not have all the strains of bacteria that the manufacture claimed to have and/or had less viable bacteria than described before expiration date. One probiotic supplement had no viable bacteria in it. That means that you might be buying a probiotic product that does not have enough live beneficial bacteria to make any difference in your gut. I found that to be misleading and that is probably one of the reasons why some people claim that probiotic supplements are not working. (4) The worse news is that nine of the supplements actually contained the bacteria Enterococcus faecium, a human pathogen that causes bacterial infections, surgical wound infection, endocarditis (An infection of the heart's inner lining), and urinary tract infections. It is considered a ‘super-bug’ due to its ability to resist many types of antibiotics. Unfortunately, quality control is definitely not the highest priority of many of the supplements companies, which puts all of us at health risk.
Probiotic Survival Rate
Another issue with probiotic bacteria is that some species of bacteria might not survive the stomach acid or the bile salt that is secreted from the gallbladder. Consuming probiotics that does not survive your stomach acid or your gallbladder bile is a waste since they get destroyed fast. (5)
How to Pick a Good Probiotic Supplement
Since the supplement market is not regulated and the FDA does not check the quality and accuracy of each supplement, it is up to us to determine if a certain supplement actually contain the right ingredients, is from a reputable company, and was not manufacture in poor quality or with harmful add-ons.
There are several factors to notice when you pick your probiotics
Price does not reflects quality. Although majority of the most quality products are more expensive (over $30), that is not always the case. Some expensive products that we examined were not very beneficial.
Effective dosage – A supplement that provide the right number of viable (live) bacteria at time of consumption. The number confirmed by research (for most bacteria) to be effective is 10 billion (10,000,000,000) viable bacteria for each strain in the supplement, NOT together.
The probiotics supplement is resistant to acid. Your stomach acid runs between 1.5 to 3.5 (pH) which is considered ultra-acidic to break down the food that you are eating. This level of acidity breaks down the bacteria. Look for a supplement that states that it is resistant to acid.
The supplement contains strain of bacteria that were found to be beneficial to health. Some supplements, for example claim health benefits that were never verified in research or were found to belong to other species of bacteria. Remember, not all bacteria have the same properties. Look for products that have a variety of bacteria that were studied in research. I attached a list of some of these below:
L. delbrueckii subsp. bulgaricus (DSM 247634)
Bacillus clausii (Enterogermina)
Saccharomyces cerevisiae variety boulardii (Biocodex strain)
Lactobacillus rhamnosus GG
Lactobacillus casei Shirota
The most beneficial supplements we found and use in our clinic require healthcare provider prescription. Since different strains of bacteria, are beneficial for different health conditions, it is better to consult with a professional healthcare provider that has studied the topic. You will benefit from probiotic product if you will be taking a good quality supplement and the 'right' type of supplement for you. An experienced healthcare provider can recommend you the probiotic supplement that would fit for your health condition.
If you wish to supplement with a good product by yourself, here are a few products that we found to have better quality and beneficial bacteria:
Frequently Asked Questions About Probiotics Consumption
You can do that by consuming pre-biotics, the fiber that bacteria like to consume to grow. Such fibers are usually cheaper than probiotics and were found to be very effective in growing the healthy bacteria in your gut. An example for that would be a group of naturally occurring polysaccharides (sugars) called inulin. Another group is Fructooligosaccharides which can be found in supplements or in fruits and vegetables such as bananas, onions, chicory root, garlic, asparagus, jícama, and leeks.
How can I improve the amount of healthy bacteria in my gut?
How will I feel when I first starting to take probiotics?
Most people do not feel any side effects. However, research show that some people had minor abdominal symptoms, such as bloating, gas, or discomfort when starting to take probiotics.
Is it safe to consume probiotics?
Good quality probiotic supplements are considered to be safe for use. Some probiotics supplements were found to have traces of harmful bacteria and should be avoided. Pregnant women, children, or patients with chronic conditions, such as compromised immune system, should consult with a physician before starting probiotics.
Will these probiotic bacteria stay in my gut forever?
How long do I need to take probiotics?
That depends on the health condition you are having. Most health conditions (such as gut dysbiosis, chronic inflammation, etc.) will require at least 3 to 6 months of daily use of probiotics. As maintenance, I recommend at least one month of daily use of probiotics every six months. If you were taking antibiotics, my recommendation is one month of probiotics for every week of antibiotics.
Ouwehand AC, Salminen S, Isolauri E. Probiotics: an overview of beneficial effects. Lactic Acid Bacteria: Genetics, Metabolism and Applications. 2002:279-289. doi:10.1007/978-94-017-2029-8_18.
Hawrelak JA, Myers SP. The causes of intestinal dysbiosis: a review. Alternative Medicine Review. June 2004:180-197. http://www.altmedrev.com/publications/9/2/180.pdf.
Dinan TG, Cryan JF. Melancholic microbes: a link between gut microbiota and depression? Neurogastroenterology & Motility. 2013;25(9):713-719. doi:10.1111/nmo.12198.
Hamilton-Miller J, Shah S, Winkler J. Public health issues arising from microbiological and labelling quality of foods and supplements containing probiotic microorganisms. Public Health Nutrition. 1999;2(02). doi:10.1017/s1368980099000282.
Bao Y, Zhang Y, Zhang Y, et al. Screening of potential probiotic properties of Lactobacillus fermentum isolated from traditional dairy products. Food Control. 2010;21(5):695-701. doi:10.1016/j.foodcont.2009.10.010.