What are probiotics?

Probiotics

Probiotics are temporary, helpful microorganisms (like bacteria and yeast) that when consumed provide a benefit to the host (that’s us!). We all have bacteria and other microorganisms that help us digest food, destroy dangerous cells, and produce vitamins. 

There are millions of strains of probiotics and they each provide a different effect on the body, which may be positive or negative. For this reason, we encourage a strain-specific approach to specifically target whichever symptom you are aiming to address.  For more information on well-researched probiotic strains for certain ailments, check out the US Probiotic Guide here. 

Probiotic Myths: 

1. Listing the FULL name doesn’t matter
   • The strain name differentiates it from others in the same family because probiotics act differently. It’s really important to know which one specifically you are using so that you can target specific symptoms or conditions without exacerbating them.
   • It’s a red flag when a probiotic company won’t disclose the strain name and you can usually find a brand that will disclose this information.
2. Probiotics are only good for general health 
   1. Probiotics can be helpful for many ailments and in fact are more effective if used strain-specifically to target symptoms. 
   2. Probiotic strains have efficacy for IBS symptoms, bloating, abdominal pain, inducing remission in UC, reducing relapse rate in Crohn’s, and others like colic, UTI, bacterial vaginosis, Giardia, and reducing infection risk. 
3. Only “broad spectrum” probiotics with multiple strains are helpful 
   1. Again, we want to be really specific about the strains we are using.. If the strain name isn’t listed, we won’t know if it’s helpful or not. 
4. All probiotics are helpful 
   1. All probiotics are not helpful for all situations. For example, Culturelle has been shown to be effective in UC but has shown negative results in Crohn’s. Culturelle contains strains Lactobacillus Rhamnosus GG and Lactobacillus johnsonii LAI. 
5. Probiotics are best taken on an empty stomach
   1. Probiotics actually work better or more synergistically when taken with food, particularly with a prebiotic or soluble fiber.  
6. You shouldn’t take a probiotic when on an antibiotic
   1. Taking a probiotic can be helpful, but you want to be strategic with timing because an antibiotic will kill all the bacteria – good and bad. It’s best to take the probiotic 4 hours apart from the antibiotic and for several weeks after the antibiotic regimen is completed. 
7. Taking a probiotic permanently alters your gut flora
   1. Probiotics are not permanent visitors and require prebiotic fibers to flourish and sustain long-term results. Remember, your gut microbiome is like a plant and must be fed appropriately to grow and thrive! 
8. Taking a probiotic can replace a healthy diet 
   1. Prebiotics work best alongside a healthy diet, rich in plants and prebiotic fibers. If there aren’t enough soluble fibers and plant pigments in the diet, gut bacteria can starve and die off. This is a primary argument for why restricting intake and fiber is problematic in IBD. Your gut microbiome needs to be nourished regularly! 
9. Probiotics from the same family are the same 
   1. Probiotic families do share similarities, kind of like cousins or siblings share similarities in a human family. But, probiotic families are large and they also share differences, just like siblings or cousins in a family would! Probiotic research continues to grow and we continue to learn more about them and how different they are. 
10. There isn’t enough evidence for the use of probiotics 
    1. Many feel that due to the lack of large studies on probiotics, that they should not be considered but that doesn’t mean that good quality evidence in smaller cohorts doesn’t exist. Taking this into consideration and coupling it with what we know of prebiotics and nourishing dietary patterns, the overall benefits are amplified. 

Questions to ask when choosing a probiotic: 

• Does it list the full name, including strain name?
• Does it have evidence for its use in your symptoms/condition?
• Does it reach the colon and have evidence that it does? 
• What is your experience with it?
• Should I reach out to my provider for help (make sure you contact one that is well-versed in this area, not all are)?

How long should a person stay on their probiotic?

If taking a probiotic, it is recommended to stay on it for at least 4 weeks and monitor outcomes.  This is about how long it would take to see improvements depending on the condition.  Due to a person’s genetic makeup, their response to a probiotic may be different from others and may warrant them not taking a probiotic. 

FAQ’s

Why aren’t probiotics routinely recommended in a doctor’s office?  Should we be seeing a doctor that encourages the use of probiotics? 

Probiotics can come with risks, especially in those with weakened immunity.  According to the National Institutes of Health, probiotics have been linked to fungi in the blood, bacteremia, or other infections.  Due to probiotics being dietary supplements and not medications, physicians may be weary to recommend these products. 

How do I know if I’m purchasing a reputable brand/probiotic? 

Make sure the brand you’re choosing from mentions the specific strain and how much is in the strain.  It is also recommended to purchase a brand of probiotics that have performed quality testing and is third-party tested.  

Is there a specific amount of probiotics that I should be taking? Ex: 5 billion vs. 15 billion?

Probiotics can come in the form of powder, capsule, liquid, and others.  Colony forming units or CFU do not determine the health benefits of a probiotic.  The CFU should be mentioned at the expiration date of the product and not when it was manufactured.  Taking a lower CFU probiotic may be a good place to start when checking for tolerance.