Choosing the right probiotic

By Dr. Vivan Bizios


These days, probiotics have gained widespread popularity among those seeking to improve their digestion and overall health.  The marketplace offers a plethora of options when it comes to probiotics.  How do you choose the best one for your individual needs?

Here are some tips:

What are you taking them for?

Some of the most common reasons people seek out probiotics are to help with bloating, diarrhea, constipation, irritable bowel syndrome and overall gut health.  Strains like Saccharomyces boulardii are helpful for traveler’s diarrhea and food poisoning while Bifidobacterium bifidum is helpful in regulating bowel movements and irritable bowel syndrome (IBS).

Recently the human microbiome project began identifying microbial “fingerprints” associated with certain disease states.  “Obesogenic gut microbiota” or gut flora characteristic in obesity is one example of where the research is heading[1].  Other associations are being made with diabetes, cardiovascular disease, autoimmune diseases, depression and anxiety.

Appropriate matching of probiotic strains and strengths to the condition ensures you are getting the most from your probiotic.

What forms exist?

Probiotics can be purchased in many forms, ranging from powders, liquids, capsules, tablets, suppositories and chewables.  Many require refrigeration while others are shelf-stable.

Of course, another option is food.  Fermented foods like sauerkraut, kombucha, kimchi, yogurt, and kefir can be helpful in maintaining digestive health.  Although, many patients may require additional supplementation to achieve a therapeutic benefit.

Do all probiotics need to be refrigerated?

The simple answer is “yes” as most commercial strains are extremely delicate and sensitive to heat, moisture, oxygen and light. These include many common strains like Lactobacillus and Bifidobacterium.

However, shelf-stable probiotics do exist. These are specific strains including soil based organisms (SBO) that are heat stable, ideal for those living in warmer climates or for travelling.

How much should I take?

The CFU (Colony-forming unit) is the unit of measurement for viable bacteria in the product. The range can be from millions to billions.

Depending on your life stage, here are some general guidelines.  For children, 5-10 billion CFU per dose, healthy adults 5-10 billion CFU per dose and older adults may range from 5-20 billion CFU per dose.

It is important to note that more isn’t always better and dosing should also take into account the type and severity of the condition being addressed and the overall health status of the patient. Some strains may also be contraindicated in severely immune-compromised individuals and those with fungal conditions.  It is best to consult with a Naturopathic Doctor (ND).

What strains are the best?

This depends on what you are treating. Nevertheless, each product should state the genus, species and strain (i.e. Lactobacillus acidophilus CUL-60).  Reputable companies will identify the actual strain (i.e. CUL-60) and will conduct third party testing to verify it’s presence and viability post-production. They will also properly label their products with potency at expiration.  And yes, this can be costly, so expect to pay a little extra.

Choose strains that are backed by research.  Much like pharmaceutical research, individual probiotic strains are clinically evaluated for their impact on human health. These studies help ND’s make informed evidence-based decisions when recommending a probiotic.

A final note, research has demonstrated that probiotics are transient organisms that need to be replaced regularly.  Ensure you support this process by taking an adequate daily dose of fiber (feeds your good bacteria), adding some fermented foods at mealtime and choosing a well-suited probiotic for your individual health needs.

[1] Obesity, Diabetes, and Gut Microbiota.  Giovanni Musso, Roberto Gambino, Maurizio Cassader, Diabetes Care 2010 Oct; 33(10): 2277-2284