Is there a way to choose the right probiotic for you?
The value of the global probiotics market in 2021 was just under sixty billion US dollars.[1] That’s a lot of options when it comes to choosing the right probiotic for you.
A basic search for probiotics on iHerb, the popular online supplement retailer, can deliver up to five hundred confusing options. For example, gender-specific mixtures to formulas with similar names, such as “complete” which have completely different ingredients.
Most of the time, if you are just getting started, choosing based on everyone else’s good reviews seems like the only option.
What if you could choose a more specific probiotic to your needs?
Better still, what if you could look at the species in a formula, their amounts and identify the ones you know have some genuine research behind them for your condition?
In part one of our beginner’s guide to probiotics, we looked at the best time to take probiotics, the difference between shelf-stable and probiotics in the fridge, what makes an excellent over-the-counter formula, and some basics around what makes a microorganism a probiotic.
In this article, we’re going to bring together some of the conditions where I prescribe probiotics successfully in the clinic, along with some research into specific strains that might help.
Let’s start with some fun stuff before the more condition-specific evidence and look at some more cutting-edge ideas about how probiotics might be able to help.
Can probiotics extend your life?
A caveat in this discussion is that most of the research about probiotics and longevity is in animals, so be patient.
Some of this research may not materialise in humans, but hey, if it does, maybe you heard it here first?!
A widespread strain patented for research, L.plantarum GKM3, was fed to mice throughout their lifetime. The study found that just this strain delayed the ageing process in the brain, reducing the age-related cognitive impairment and the rust caused by oxidation.[2]
Building on this, another patented species of L.plantarum has shown positive anti-ageing effects in animal studies, suggesting it is the “ideal candidate for promotion as a next-generation probiotic.”[3]
Speculation about probiotics extending your lifespan or, what’s more appropriately, healthspan is fun.
However, the answer as to why isn’t clear. It may, though, lie in probiotics’ benefit in some of the most widespread diseases.
For example, let’s continue with one of my favourite strains of probiotics. L.plantarum is part of well-known formula called VSL#3, and its role in managing a condition that affects one-third of the world’s population, non-alcoholic fatty liver disease.[4]
Why fatty liver specifically?
Current estimates suggest that fatty liver is accelerating at an alarming rate. It’s connected to metabolic disorders such as type 2 diabetes (over seventy per cent of people with type 2 diabetes have a fatty liver)[5]and an increased risk of cardiovascular disease.[6]
Back to L.plantarum as part of VSL#3.
Alongside other strains of probiotics, two sachets of four hundred and fifty billion CFUs daily for three months (that’s nine hundred CFUs of probiotics in total!) reduced triglyceride levels, highly sensitive C-reactive protein (a key marker in cardiovascular disease). It also reduced ALT, AST and GGT enzymes often elevated in your blood tests when diagnosed with fatty liver.
Why is this important for our longevity conversation?
Triglycerides and HS-CRP are indicators on a blood test that things are showing a negative trend for your health risks over the coming decade. One of the critical things they help us understand about a person’s health is their potential level of inflammation.
HS-CRP, in particular, predicts sudden cardiac death among healthy people with no history of cardiovascular problems. It also predicts stroke.[7]
Based on this, it is now easier to understand why L.plantarum and other probiotics in the VSL#3 formula reducing this inflammation can, in essence, help you live longer!
L.plantarum helps other markers of inflammation.
This action is vital for those looking to take a specific probiotic strain for their health. A meta-analysis looking at studies containing L.plantarum since 2019 found that it increased anti-inflammatory chemicals in the immune system and decreased inflammatory chemicals simultaneously.
This ability to enhance the anti-inflammatory parts of the immune system is vital in helping people with allergic responses.
The anti-inflammatory component we are talking about is called Interleukin-10 (IL-10), and its enhancement by probiotic strains like L.plantarum seems to be the key way probiotics are getting attention for treating conditions such as allergic rhinitis.
Let me explain.
People with allergies such as hay fever often have an imbalance in the T-helper cell component of their immune systems. There are two T-helper cell systems, Th1, which responds to viruses and bacteria inside the cells, and the Th2 cells react to bigger allergens, such as parasites that can come from outside the body. Whilst they often work together, one of these systems can become dominant after continued exposure.[8]
In people with allergies, the dominant T-helper system is often the Th2 one.[9]
Why is this important regarding how probiotics like L.plantarum help allergies?
Remember IL-10 and its anti-inflammatory action? Well, one of the other things probiotics can help with is to balance the Th1 and Th2 systems in people with allergic rhinitis. A systematic review and meta-analysis published in May 2022 found that probiotic supplementation effectively reduced allergic rhinitis symptoms and improved the quality of life for those living with it.[10]
Some specific strains help with allergic rhinitis aside from L.plantarum.
One of these strains has a long name, Bifidobacterium animalis subsp. Lactis BB12. This strain which we’ll abbreviate to B.lactis has been involved in two studies of note recently.
The first was looking at how probiotic formulas could work as a preventative for allergic rhinitis in children. Three months before the pollen season started, researchers gave a formula including B.lactis. Participants treated with the probiotics experienced less severe symptoms than controls. In parallel, probiotic-treated children also needed less symptomatic treatment than the control group.[11]
Another study on allergic rhinitis using B.lactis again alongside L.plantarum and another of my favourite strains, L.rhamnosus, helped to reduce hay fever symptoms such as runny nose and itchy eyes, improving the general quality of life and the Th1/Th2 balance we looked at earlier.[12]
I’d like to add my own clinical experience to this one. Especially in my Australian practice (Melbourne is considered the “allergy capital of the world”), I have used probiotic formulas with the above strains preventatively numerous times with significant and, often surprising, success for my patients.
It’s worth a try if you are living with consistent allergy symptoms come spring/summer.
Probiotics can help prevent hay fever symptoms, but what about colds and flu?
As well as some of the digestive benefits for conditions like irritable bowel syndrome (IBS) from part one of this beginner’s guide, my first real encounter with the power of probiotics used preventatively was for colds and flu.
In the research reviews, they’ll be referred to as upper respiratory tract infections (URTI) if you want to do your own research. Two Lactobacillus strains, L.rhamnosus and L.paracasei, often pop up as crucial ingredients in the probiotic formulas used.
For example, these two strains, along with our popular L.plantarum, have been shown to decrease the total incidence of respiratory infections and shorten their duration.[13]
This immune action isn’t just for colds and flu.
Probiotics might be able to help with SARS-CoV2 infections. For example, a small study found that a multi-strain probiotic including L.paracasei, L.plantarum and two different strains of B.lactis, amongst others, a high dose of eight hundred billion CFU three times a day helped to reduce the risk of developing respiratory failure in severe COVID-19 patients.[14]
As we get to grips with new variants of COVID-19, our understanding of what can help is too. Diarrhoea has been a common symptom for those with more severe encounters with COVID-19. One of the reasons for this is the high concentration of ACE2 receptors that allow the spike protein to enter the body in the upper oesophagus, small intestine and colon. This makes the digestive system a focus for the virus to invade the body.[15]
A study with Chinese patients used a combination of Bifidobacterium longum, Lactobacillus bulgaricus, and Streptococcus thermophilus given at a dose of roughly sixty billion CFU daily.
Even though fifteen per cent of the patients had diarrhoea, the probiotic formula shortened the duration of it. As a bonus, compared with a control group not taking the probiotic formula, participants using the probiotics showed a significantly reduced time to achieving a negative nucleic acid test with two key inflammatory indicators also decreased.[16]
What about probiotics for depression?
If you look to your right, you’ll see a small box offering a free e-book breaking down how much probiotics can help the brain. Still, to look at how probiotics might be therapeutic for you as a beginner, let’s look at probiotics and depression.
A small study using Lactobacillus fermentum LF16, L.rhamnosus LR06, L.plantarum LP01, and Bifidobacterium longum BL04 looked at how some probiotics species might affect sleep, mood and other personality traits like anger and fatigue.
I found this study interesting because it measured the above at three-week intervals. Still, it was also double-blind and placebo-controlled, meaning that all the participants thought they were taking the probiotics.
In conclusion, significant improvement was seen in the mood with a reduction in depressive state, anger and fatigue, with a bonus improvement in sleep quality.[17]
The studies here are definitely early. However, recent meta-analyses have consistently come up positive. It seems that without confirmation of specific strains just yet, to give you the best chance of getting something out of it, the dosage needs to be above one billion CFU. The duration of time over eight weeks before seeing any change.[18]
Personally, in the clinic, I tend to use a higher dose of CFUs, around fifty to one hundred, depending on the gut-brain situation, for around twelve weeks before assessing how things are going.
This recommendation leads me to recommend that sometimes if you are unsure which probiotic to choose, get a healthcare practitioner to help you.
In this article, I’ve attempted to list some specific strains of probiotics to look out for to help you choose the right probiotic for you. Honestly, if you wish to “try probiotics and see what happens” with nothing specific in mind, you may end up disappointed if you don’t give things the right amount of time.
With that said, part one of our beginner’s guide introduced probiotics in general; hopefully, with part two, you can be a little more intentional when choosing the right probiotic for you. It doesn’t matter what you want to achieve. Whether it be hay fever, depression or making your immune system more effective. There should be formulas available with some of the specific species or strains we’ve discussed!
Hope this helps xx
References
[1] https://www.grandviewresearch.com/industry-analysis/probiotics-market, viewed 15th November 2022.
[2] Lin SW, Tsai YS, Chen YL, et al. Lactobacillus plantarum GKM3 Promotes Longevity, Memory Retention, and Reduces Brain Oxidation Stress in SAMP8 Mice. Nutrients. 2021;13(8):2860. Published 2021 Aug 20. doi:10.3390/nu13082860
[3] Kumar A, Joishy T, Das S, Kalita MC, Mukherjee AK, Khan MR. A Potential Probiotic Lactobacillus plantarum JBC5 Improves Longevity and Healthy Aging by Modulating Antioxidative, Innate Immunity and Serotonin-Signaling Pathways in Caenorhabditis elegans. Antioxidants (Basel). 2022;11(2):268. Published 2022 Jan 28. doi:10.3390/antiox11020268
[4] Riazi K, Azhari H, Charette JH, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7(9):851-861. doi:10.1016/S2468-1253(22)00165-0
[5] Lee CH, Lui DT, Lam KS. Non-alcoholic fatty liver disease and type 2 diabetes: An update. J Diabetes Investig. 2022;13(6):930-940. doi:10.1111/jdi.13756
[6] Chen B, Tang WHW, Rodriguez M, et al. NAFLD in Cardiovascular Diseases: A Contributor or Comorbidity? [published online ahead of print, 2022 Oct 14]. Semin Liver Dis. 2022;10.1055/s-0042-1757712. doi:10.1055/s-0042-1757712
[7] Bassuk SS, Rifai N, Ridker PM. High-sensitivity C-reactive protein: clinical importance. Curr Probl Cardiol. 2004;29(8):439-493.
[8] Chaplin DD. Overview of the immune response. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S3-S23. doi:10.1016/j.jaci.2009.12.980
[9] Maggi E. The TH1/TH2 paradigm in allergy. Immunotechnology. 1998;3(4):233-244. doi:10.1016/s1380-2933(97)10005-7
More references!
[10] Luo C, Peng S, Li M, Ao X, Liu Z. The Efficacy and Safety of Probiotics for Allergic Rhinitis: A Systematic Review and Meta-Analysis. Front Immunol. 2022;13:848279. Published 2022 May 19. doi:10.3389/fimmu.2022.848279
[11] Anania C, Di Marino VP, Olivero F, et al. Treatment with a Probiotic Mixture Containing Bifidobacterium animalis Subsp. Lactis BB12 and Enterococcus faecium L3 for the Prevention of Allergic Rhinitis Symptoms in Children: A Randomized Controlled Trial. Nutrients. 2021;13(4):1315. Published 2021 Apr 16. doi:10.3390/nu13041315
[12] Ried K, Travica N, Paye Y, Sali A. Effects of a Probiotic Formulation on Seasonal Allergic Rhinitis in Adults-A Randomized Double-Blind Placebo-Controlled Trial: The Probiotics for Hay Fever Trial. Front Nutr. 2022;9:887978. Published 2022 May 23. doi:10.3389/fnut.2022.887978
[13] Du T, Lei A, Zhang N, Zhu C. The Beneficial Role of Probiotic Lactobacillus in Respiratory Diseases. Front Immunol. 2022;13:908010. Published 2022 May 31. doi:10.3389/fimmu.2022.908010
[14] d’Ettorre G, Ceccarelli G, Marazzato M, et al. Challenges in the Management of SARS-CoV2 Infection: The Role of Oral Bacteriotherapy as Complementary Therapeutic Strategy to Avoid the Progression of COVID-19. Front Med (Lausanne). 2020;7:389. Published 2020 Jul 7. doi:10.3389/fmed.2020.00389
[15] D’Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L. Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management. Clin Gastroenterol Hepatol. 2020;18(8):1663-1672. doi:10.1016/j.cgh.2020.04.001
[16] Wang H, Wang Y, Lu C, et al. The efficacy of probiotics in patients with severe COVID-19. Ann Palliat Med. 2021;10(12):12374-12380. doi:10.21037/apm-21-3373
[17] Marotta A, Sarno E, Del Casale A, et al. Effects of Probiotics on Cognitive Reactivity, Mood, and Sleep Quality. Front Psychiatry. 2019;10:164. Published 2019 Mar 27. doi:10.3389/fpsyt.2019.00164
[18] Musazadeh V, Zarezadeh M, Faghfouri AH, et al. Probiotics as an effective therapeutic approach in alleviating depression symptoms: an umbrella meta-analysis [published online ahead of print, 2022 Mar 29]. Crit Rev Food Sci Nutr. 2022;1-9. doi:10.1080/10408398.2022.2051164
