When it comes to questions in the clinic, probiotics and their uses are top of the list. Probiotics are one of the most frequent over the counter formulas patients are using or interested in using before attending their first consultation with me.
Their popularity isn’t isolated to my patients either. One review estimates that yearly sales of probiotics will eclipse US$64 billion by 2023.[1]
If you find yourself engaging in trying them for your own use but don’t know where to start, I thought a beginner’s guide might be a valuable tool.
This guide will look at what makes a bacteria probiotic, some evidence of its benefits, and how to choose the best ones for you.
Probiotics from ancient times to the present day
In Latin, the word “probiotic” means “life”[2], first coined in the sixties by Lilly and Stillwell[3] , which makes perfect sense if you think about it. The first recorded awareness of the presence of “life” within food, particularly fermented foods, was over ten thousand years ago.[4]
Turn the clock to 1999, and the definition of probiotics is “live micro-organisms in foods such as yoghurt and other dairy products.[5]
As the sophistication of technology evolved, so did our understanding of probiotics. In 2001, an expert panel supported by the World Health Organisation (WHO) came up with the definition of probiotics we use now – “live organisms that, when administered in adequate amounts, confer a health benefit on the host.”[6]
This definition began looking at probiotics as supplements rather than a bonus ingredient in food.
Or at least this is my point of view. I believe this also caused a lot of confusion for people who desire to try probiotics to get in on some of those health benefits for the host.
The problem is that the probiotics in fermented foods such as kefir aren’t the same or as diverse as the probiotics in the capsule you buy over the counter. So you can imagine then the disappointment after reading an article about probiotics having a positive effect on “fill in the blank condition” and the kefir not cutting it.
This disappointment is why I’m glad you’re here.
Hopefully, by the end of this article, I’ll be able to help you get a sense of how fermented foods and probiotics play a role for you.
First, let’s look at probiotics and how they are named to make a little more sense of the evidence. Furthermore, knowing how the strains are named can help you identify the specific ones that can help you check the labels of over the counter products.
In the beginning, most probiotics that could produce lactic acid were at the forefront of research and clinical therapy. From this, lactic acid bacteria or LAB, are seen as the most important for helping people.
Commercial strains in your formulas are classified using the genus, species, subspecies and even nicknames. For example, Lactobacillus rhamnosus GG, a well-used strain in most formulas, would be named via the following:[7]
Genus: Lactobacillus
Species: rhamnosus
Subspecies: None
Strain Designation: GG
Strain Nickname: LGG
When you start to see the designations and subspecies names in the formulas, you know you are onto something.
These are the most likely strains to have some research on them.
A good rule of thumb (though not one hundred per cent) is to look at the names on the label of your probiotic and see if they have numbers coming after them if there is no nickname like the LGG.
For example, Bifidobacterium animalis lactis DN-173 010. It almost sounds like a rocket or a newly found star! If you type in the full name, it is easier to see some of the research.
For instance, in the case of Bifidobacterium animalis lactis DN-173 010, you’ll find a groundbreaking study published in 2002 that showed this strain speeds up digestive transit time in women.[8] This strain-specific study went on to form the basis of using probiotics to help people living with constipation or IBS-C (irritable bowel syndrome with constipation as a feature).[9]
Is there any actual science on how probiotics help with specific conditions?
You can read multiple articles on probiotics for the immune system, mental health, and digestive issues such as constipation throughout this website.
Some of the main clinical applications are for use around managing the side effects of antibiotic use[10], improving symptoms of irritable bowel syndrome (IBS)[11] and, interestingly, total cholesterol.[12]
One of the characteristics of what makes a micro-organism a probiotic may be one of the main reasons why it helps.
There are four main characteristics that a bacteria has to fulfil to be a probiotic:
- Probiotics must be tolerant to digestion (they can’t exert a health benefit if they get burnt up by stomach acid).
- Probiotics must have an anti-microbial action
- Ability to interact with fats and proteins
- Probiotics must have a viable ability to form colonies (if bacteria can colonise within the digestion, the benefits are more pronounced).[13]
Now it’s the ability to balance and, in some cases, clear, non-desirable microbes that give probiotics some exciting potential in many different conditions. This function is down to the presence of something called “dysbiosis.” If you are new to this term, dysbioisis is the loss or gain of bacteria that either promote health or disease, respectively.[14]
Causes of dysbiosis such as the western diet, antibiotics, and physical and psychological stress mean it’s almost hard to avoid today.[15] When dysbiosis occurs, healthy bacteria get replaced by more non-desirable bacteria that start to increase inflammation in both the digestive system and the rest of the body. You may have also heard of the term “leaky gut.” Dysbiosis is one of the things that drive it.
One of the best ways I’ve had it explained to me is to see the digestive tract like a car park.
Each space only has room for one car. Or, in the case of our metaphor here, one bacteria.
Generally, we want to have most car spaces filled with beneficial bacteria or probiotics. But what can happen over time is that as the spaces open, they can be filled with negative bacteria, slowly changing the balance of the total amount of bacteria in the car park to a less desirable place.
One of the cool things about probiotics and one of the reasons researchers think they are beneficial is their ability to suppress the harmful bacteria, thus stopping them from taking over the car park!
What makes a good over the counter probiotic?
We’ve touched on the strain specifics and how to identify whether or not your product has the right, evidence-based strain in it, but there are a few other things. For example, how do you know what quantities of the strains are in the formula you’re considering?
You may have seen the initials CFU next to the numbers. CFU stands for colony-forming units and represents the number of viable cells available. Often, they’ll be in the billions, which, more than anything, just gives a sense of the scale at which bacteria inhabit the body.
To put this into context further, one gram of your stool will contain around 100 billion microbes![16]
Sorry I love fun facts.
Let’s get back to the labels and colony-forming units as I think it’s important due to what I think is a bit of a sneaky manufacturing trick.
Whilst most brands in 2022 will openly put the species and amounts on their labels, this listing is at the time of manufacture. Now, this is especially pertinent when trying to make the right decision for a probiotic formula.
The levels of colony-forming units in shelf-stable probiotics will diminish over the time they are on the shelf. I’ll give you an example of how a more honest brand manufactures its shelf-stable formula to provide you with some context.
One particular brand advertised twenty billion CFU on the label of their shelf-stable formula. Many people don’t know that at the time of manufacture, that same formula had double the amount of CFU to account for the degradation of the probiotics over time.
I would go on a limb and generalise that Australian probiotic brands regulate and reinforce these practices.
If you are out of Australia, make sure you research the brand’s practices.
Why? Because if you get a shelf-stable probiotic formula closer to its expiry date, then understand that a deficit between the label and what you’re getting may be substantial.
What if you can’t be bothered to make all these inquiries for your shelf-stable probiotic?
The solution is easy. Purchase a probiotic that has to be refrigerated. That way, the CFU that were there at the time of manufacture remain for the life of the formula. It seems like a good deal to me!
I feel like this separates therapeutic probiotic formulas that you take with the intent to benefit from and food-based products that have probiotics added. This contrast is just my point of view, but I have heard from patients that they’ve tried probiotics in fermented foods, and it hasn’t worked.
In the most polite way possible, I ask, “which strains of probiotics in the fermented foods were they hoping would benefit their condition?” The answer is rarely specific. This question only illustrates why some people don’t get the results they are looking for using fermented foods. Don’t get me wrong, probiotic supplements and probiotics in fermented foods can coexist.
Once again, my point of view on this comes from more of a clinical perspective. Strain-specific probiotics first, and probiotics in fermented foods for maintenance afterwards. There are multiple other reasons why this is the case, but fermented foods’ prebiotic and postbiotic content is significant.[17]
When is the best time to take probiotics?
I wanted to include this one before concluding the article. Mainly because it’s easy, take your probiotics with or after any of the main meals in your day. This timing means your gastric acid will be slightly more dilute, and the probiotics will have a better chance of getting through the stomach to areas of the digestive system where they can help.
Probiotics can be beneficial. As our understanding grows, along with the technology to measure their effects within the body, I believe we will continue to find new ways to utilise them to get a therapeutic benefit. Hopefully, this beginner’s guide brings you one step closer to getting started.
Hope this helps x
References
[1] https://www.prnewswire.com/news-releases/probiotics-market-size-to-exceed-usd-64-billion-by-2023-global-market-insights-inc-578769201.html, viewed 7th June 2022.
[2] Ozen M, Dinleyici EC. The history of probiotics: the untold story. Benef Microbes. 2015;6(2):159-165. doi:10.3920/BM2014.0103
[3] Lilly, D. M., & Stillwell, R. H. (1965). Probiotics: growth-promoting factors produced by microorganisms. Science, 147(3659), 747-748.
[4] Ozen M, Dinleyici EC. The history of probiotics: the untold story. Benef Microbes. 2015;6(2):159-165. doi:10.3920/BM2014.0103
[5] Macfarlane GT, Cummings JH. Probiotics and prebiotics: can regulating the activities of intestinal bacteria benefit health?. BMJ. 1999;318(7189):999-1003. doi:10.1136/bmj.318.7189.999
[6] Hill C, Guarner F, Reid G, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514. doi:10.1038/nrgastro.2014.66
[7] https://ods.od.nih.gov/factsheets/Probiotics-HealthProfessional/, viewed 7th June 2022.
[8] Marteau P, Cuillerier E, Meance S, et al. Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study. Aliment Pharmacol Ther. 2002;16(3):587-593. doi:10.1046/j.1365-2036.2002.01188.x
More references!
[9] Agrawal A, Houghton LA, Morris J, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2009;29(1):104-114. doi:10.1111/j.1365-2036.2008.03853.x
[10] Shahrokhi M, Nagalli S. Probiotics. [Updated 2021 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553134/
[11] Dale HF, Rasmussen SH, Asiller ÖÖ, Lied GA. Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients. 2019;11(9):2048. Published 2019 Sep 2. doi:10.3390/nu11092048
[12] Wang L, Guo MJ, Gao Q, et al. The effects of probiotics on total cholesterol: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(5):e9679. doi:10.1097/MD.0000000000009679
[13] Kim JA, Bayo J, Cha J, et al. Investigating the probiotic characteristics of four microbial strains with potential application in feed industry. PLoS One. 2019;14(6):e0218922. Published 2019 Jun 26. doi:10.1371/journal.pone.0218922
[14] Wilkins LJ, Monga M, Miller AW. Defining Dysbiosis for a Cluster of Chronic Diseases. Sci Rep. 2019;9(1):12918. Published 2019 Sep 9. doi:10.1038/s41598-019-49452-y
[15] Hawrelak JA, Myers SP. The causes of intestinal dysbiosis: a review. Altern Med Rev. 2004;9(2):180-197.
[16] Allaband C, McDonald D, Vázquez-Baeza Y, et al. Microbiome 101: Studying, Analyzing, and Interpreting Gut Microbiome Data for Clinicians. Clin Gastroenterol Hepatol. 2019;17(2):218-230. doi:10.1016/j.cgh.2018.09.017
[17] Shimizu, H., Masujima, Y., Ushiroda, C. et al. Dietary short-chain fatty acid intake improves the hepatic metabolic condition via FFAR3. Sci Rep 9, 16574 (2019). https://doi.org/10.1038/s41598-019-53242-x
