Probiotics and you

There are millions of bacteria in your body. There are also seemingly millions of probiotics products. Picking the right probiotic can seem daunting. Fortunately, the scientific data regarding probiotics is growing and even demonstrating benefits we are just learning to understand. Here are answers to commonly asked questions about probiotics and how to pick a probiotic off at your local store or online: 

What are probiotics? 

Probiotics are the good bacteria in your body. Probiotic means "for life" in Greek. Ancient civilizations have long had recipes for fermented foods or products. I wrote an article about the microbiome in our 2018 Almanac called "Your Miraculous Microbiome" if you want to learn more.

Who should take a probiotic? 

Everyone. I'd argue probiotics are the most important, number one in my top five, out of all the supplements you can take. 

How many probiotics should I be taking daily?

On average, one capsule daily is enough. How many billions is another question highly dependent on the type of probiotic strains used and your digestive health. A good starting point is around ten billion-plus or more for blended refrigerated probiotics. If you are dealing with a shelf-stable product and know the different strains of bacteria, however, as little as 0.5 to 1 billion can suffice.

Are refrigerated or shelf-stable probiotics better?

I always answer this question with another question: Which one are you going to remember to take? There are exceptional products in both categories available. Refrigeration doesn't necessarily mean it's better, and shelf-stable doesn't mean it's worse. They are just different. Both are effective (Govender et al.). Don't let the marketing fool you. Stores will refrigerate shelf-stable probiotics simply because they sell better that way. If you forget you have a probiotic in your refrigerator, what good is it to you? 

What is the best way to take a probiotic? 

It depends on your digestive health. Take probiotics separately from hot foods or drinks (and don't mix them into hot foods/beverages). Powder, liquid, capsule, gummy, or other methods of administration are all options. If you want to help probiotics travel safely through to your colon, take them with protein and fat-based foods. Fermented milk products (or similar for vegans), such as yogurt or kefir, are great ways to take probiotics (fat+protein).

Are sustained-release probiotics more effective? 

Yes and no. Some individuals need to get the majority of probiotics into their lower intestines. If you're one of those, then a slow-release probiotic is best for you, especially with bifidobacteria, which are more sensitive to environmental shifts. Otherwise, you need probiotics from your mouth down because oral health relies on a good balance of bacteria (Burton et al.) (Huang et al.) (Della Riccia et al.) (Krasse et al.) (Zhang et al.). Yes, stomach acid does kill a good chunk of probiotics (about 60%), but don't we eat yogurt and other fermented foods with probiotics for similar benefits?

Do I need to take a prebiotic?

Prebiotics are always a bonus. They help feed the probiotics you're ingesting and even the ones currently in your digestive tract. While they are not necessary as a supplement, they positively impact overall health and well-being (Carlson et al.).

Do I get enough probiotics from yogurt? 

If your yogurt is a conventional product, no. Studies have demonstrated that many probiotics left in name brand yogurts have negligible amounts that survive, primarily due to conditions surrounding cold chain interruption, pH, and packaging (Ferdousi et al.)(Nyanzi et al.). However, if your yogurt lists a specific amount of probiotics, say 16 billion, for example, regulations require 16 billion probiotics to be left by the date of expiration. Otherwise, it's just a marketing tool. What if you're making your yogurt or other fermented foods and consuming them daily? In that case, yes, you are likely getting enough. Naturally fermented foods are incredible for increased health. The advantage to a supplement is the sheer number of probiotics you can get in a single dose and, obviously, the convenience. 

How long should I take a probiotic? 

Short answer? Forever. Longer answer: toxins constantly bombard our environment and food, not just in small quantities. We are living in a sea of chemicals that kill the good bacteria in our guts. For example, glyphosate (RoundUp) is now permanently in our ecosystem (Kanissery et al.) (Soil Association). It alone decimates the probiotics found in our digestive tracts (Rueda-Ruzafa et al.). About a million other things kill good bacteria (hello, sanitizers!), but know that we need to constantly resupply our digestive systems with probiotics due to the inherent toxins found in our environment. 

Do my kids need to take probiotics? 

That depends on their age and digestive health. You research this one yourself. It's critical to note that you will need to find an age-appropriate probiotic for your child. As we age, the probiotics in our digestive system become more diverse. We gain and lose certain strains of bacteria. To avoid introducing new bacteria to a child's digestive tract, find one that is age-appropriate or transient (meaning it's there to feed the good stuff but passes through, like bacillus coagulans aka Lactobacillus sporogenes). 

How old do my kids need to be to take a probiotic?

Probiotics are available for infants to seniors, so it largely depends on the product. Most options you'll find should have age recommendations. Make sure you always read the label and are buying products from a reputable company. 

Can I take probiotics while I'm on an antibiotic?

Yes, you can, as long as you do so at least two hours after taking your antibiotic. While it may seem counterintuitive because antibiotics destroy probiotics, there is enough scientific evidence to support the benefits of taking them while using an antibiotic, specifically regarding antibiotic-associated diarrhea or AAD (Rodgers et al.). In addition, certain probiotics are more beneficial to take while on antibiotics, such as Bacillus coagulans/lactobacillus sporogenes. This is because they are self-protected until they enter the proper pH in the colon, where they open up. 

Are there risks to taking a probiotic? 

Risks are rare. They generally include minor constipation or mild diarrhea, cramps, bloating, and gas. However, it is best for those with severe illnesses or compromised immune systems to talk to their doctor before taking a probiotic (Wang and Shurtleff).

Picking a Probiotic for Yourself  

Picking a probiotic is where it gets tricky. The best probiotic for you might not be the best one for me. Personalizations come into play based on your current health and related health goals. Unless you're into intense amounts of research, I advise going into your local mom and pop health food store and discussing with a team member which probiotic might be the best fit for you. 

Recommendations to better navigate the probiotics shelf include the following:

• Find a probiotic with at least 10 billion or more good bacteria cells/colony forming units (CFUs). If it is not refrigerated (shelf-stable), look for around 3 billion. 
• If you choose a refrigerated probiotic, look for strain diversity. Close to or around ten different probiotic strains minimum is ideal. 
• Start with a lower dose first to assess tolerance. Although helpful, sometimes probiotics can mildly disrupt the digestive system with temporary gas and bloating as your system adjusts. You can even start by sprinkling half a capsule on cold food or in a cold drink. Then, work your way up to higher doses as needed. 
• Find one that fits your lifestyle. On the go? Forgetful? You'd probably best do a shelf-stable probiotic. Do you have difficulty swallowing? Then a liquid or chewable would work better for you. 
• Find a probiotic that addresses your gut health needs. While any probiotic is excellent, some address more chronic conditions and sensitivities. Others restore gut flora after a round of antibiotics. 
• Familiarize yourself with these common family strains: Lactobacillus, Bifidobacterium, Saccharomyces, Enterococcus, and Bacillus (Fijan). 
• Check for common allergens and intolerances if you have them! Unfortunately, these don't help make for happy gut vibes. 
• If you know your gut is sensitive, avoid probiotics that also have prebiotics, like fructooligosaccharides (FOS). These are indigestible sugars that bacteria feed on, which can cause mild gas and cramping. 
• Always choose quality over quantity. A reputable brand is essential, especially in this category. Avoid excessive binders, fillers, preservatives, flavorings, coloring agents, and other additives. Some are common allergens, and others may have a severe negative impact on overall health and wellness. (Skocaj et al.) (Kobylewski and Jacobson) (Potera) (EPA) (Tebbey and Buttke)
• If you try one and it doesn't seem to work, it's likely not the right fit for your physiology. Instead, try a different blend, higher potency, or brand. Two to three weeks is usually enough time to know if a probiotic is working for you or not. 
• Eat and drink more fermented foods! These will always be much more biodiverse in the strains of bacteria, and they are typically very healthy for you. 
• Drink water and get regular exercise. Both go a long way to helping your natural gut flora. 
• Avoid chemicals where possible. Many chemicals in body care, cleaning suppliers, and food are highly disruptive to our microbiome. A great resource to check out how safe a product is is ewg.org. 
• Most importantly: listen to your body! No one knows you as you do.  

References/citations: 

1. Burton, JP, et al. “A preliminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters.” pubmed.gov, April 2006, https://pubmed.ncbi.nlm.nih.gov/16553730/. Accessed 10 August 2021.
2. Carlson, Justin L., et al. “Health Effects and Sources of Prebiotic Dietary Fiber.” Current Developments in Nutrition, vol. 2, no. 3, 2018, p. nzy005. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041804/#bib3. Accessed 10 August 2021.
3. Della Riccia, D. N., et al. “Anti-inflammatory effects of Lactobacillus brevis (CD2) on periodontal disease.” pubmed.gov, July 2007, https://pubmed.ncbi.nlm.nih.gov/17577323/. Accessed 10 August 2021.
4. EPA. “Provisional Peer-Reviewed Toxicity Values for Butylated Hydroxytoluene (BHT).” epa.gov, 5 6 2013, https://cfpub.epa.gov/ncea/pprtv/documents/Butylatedhydroxytoluene.pdf. Accessed 20 8 2021.
5. Ferdousi, Rohollah, et al. “Evaluation of Probiotic Survivability in Yogurt Exposed to Cold Chain Interruption.” Iranian Journal of Pharmaceutical Research, vol. 12, no. Suppl, 2013, pp. 139-144. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813376/#B5. Accessed 10 August 2021.
6. Fijan, Sabina. “Microorganisms with Claimed Probiotic Properties: An Overview of Recent Literature.” International Journal of Environmental Research and Public Health, vol. 11, no. 5, 2014, pp. 4745-4767. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053917/. Accessed 20 8 2021.
7. Govender, Mershen, et al. “A Review of the Advancements in Probiotic Delivery: Conventional vs. Non-conventional Formulations for Intestinal Flora Supplementation.” American Association of Pharmaceutical Scientists, vol. 15, no. 1, 2014, pp. 29-43. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909163/. Accessed 10 August 2021.
8. Huang, Xuelian, et al. “A Highly Arginolytic Streptococcus Species that Potently Antagonizes Streptococcus mutans.” American Society for Microbiology, 21 March 2016, https://journals.asm.org/doi/full/10.1128/aem.03887-15. Accessed 10 August 2021.
9. Kanissery, Ramdas, et al. “Glyphosate: Its Environmental Persistence and Impact on Crop Health and Nutrition.” Plants (Basel), vol. 8, no. 11, 2019, p. 499. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918143/. Accessed 10 August 2021.
10. Kobylewski, Sarah, and Michael F. Jacobson. “Toxicology of food dyes.” International Journal of Occupational and Environmental Health, vol. 18, no. 3, 2012, pp. 220-246. pubmed.gov, https://pubmed.ncbi.nlm.nih.gov/23026007/. Accessed 20 August 2021.
11. Krasse, Per, et al. “Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri.” Swedish Dental Journal, vol. 30, no. 2, 2006, pp. 55-60. pubmed.gov, https://pubmed.ncbi.nlm.nih.gov/16878680/. Accessed 10 August 2021.
12. Nyanzi, Richard, et al. “Invited review: Probiotic yogurt quality criteria, regulatory framework, clinical evidence, and analytical aspects.” Journal of Dairy Science, vol. 104, no. 1, 2021, pp. 1-19. scienedirect.com, https://www.sciencedirect.com/science/article/pii/S0022030220309991. Accessed 10 August 2021.
13. Potera, Carol. “DIET AND NUTRITION: The Artificial Food Dye Blues.” Environmental Health Perspective, vol. 118, no. 10, 2010, p. A428. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957945/. Accessed 20 August 2021.
14. Rodgers, Blake, et al. “Prescribing an antibiotic? Pair it with probiotics.” The Journal of Family Practice, vol. 62, no. 3, 2013, pp. 148-150. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601687/. Accessed 10 August 2021.
15. Rueda-Ruzafa, Lola, et al. “Gut microbiota and neurological effects of glyphosate.” NeuroToxicology, vol. 75, 2019, pp. 1-8. pubmed.gov, https://hh-ra.org/wp-content/uploads/2021/03/Rueda-Ruzafa-Gut-microbiota-and-neurological-e.pdf. Accessed 10 August 2021.
16. Skocaj, Matej, et al. “Titanium dioxide in our everyday life; is it safe?” Radiology and Oncology, vol. 45, no. 4, 2011, pp. 227-247. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423755/. Accessed 20 August 2021.
17. Soil Association. “The impact of glyphosate on soil health.” Soil Association, 18 December 2018, https://www.soilassociation.org/media/7202/glyphosate-and-soil-health-full-report.pdf. Accessed 10 August 2021.
18. Tebbey, P. W., and T. M. Buttke. “Molecular basis for the immunosuppressive action of stearic acid on T cells.” Immunology, vol. 70, no. 3, 1990, pp. 379-386. pubmed.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1384169/?tool=pubmed. Accessed 20 August 2021.
19. Wang, Yisong, and David Shurtleff. “Probiotics: What You Need To Know.” National Center for Complementary and Integrative Healh, NIH, August 2019, https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know. Accessed 18 August 2021.
20. Zhang, Ming, et al. “Lactobacillus salivarius REN Inhibits Rat Oral Cancer Induced by 4-Nitroquioline 1-Oxide.” Cancer Prevention Research, vol. 6, no. 7, 2013, pp. 686-694. American Association for Cancer Research, https://cancerpreventionresearch.aacrjournals.org/content/6/7/686.long. Accessed 10 August 2021.