How to choose a good probiotic - guidance from a Naturopathic Doctor

by Dr. Savannah Bukant, Naturopathic Doctor

I was talking with a patient recently about adding a probiotic to support her gut and skin health. She mentioned that she is already taking a probiotic and shared the brand. I took a look. I didn’t love it. I told her I had another suggestion that might work better for her.

And then I thought, this would be a helpful blog topic! I wrote this blog post to give you some insight on how to choose a good quality probiotic. There are lots of options out there, and it’s important to know what to look for when making the choice.

Probiotics are everywhere: yogurt aisles, supplement shelves, online ads. But not all probiotics are the same. Below I’ll explain how to choose a product, which strains have the best evidence for specific problems, and typical dosing ranges to consider. Where possible I’ve included recent research you can read next.

What are probiotics, and who needs them?

I want to start with a quick reminder that this is not medical advice. Probiotics are often used as a medical treatment for certain conditions and diagnoses. The following information is not to be used as medical advice and shouldn’t replace a conversation with your medical provider about what is appropriate for you personally.

Probiotics are supplements containing live strains of bacteria or yeast. They can be taken by mouth in the form of capsules, powders, or liquids. They can also be inserted vaginally or rectally. Most of the time they are taken as a capsule by mouth.

Probiotics are dosed in “billions” of colony-forming units (CFU). This high of a dose may sound excessive, but it’s relative to the number of microbes living in our intestinal tract; upwards of 100 trillion bacteria or more live just in our colon (the large intestine)!

What do probiotics do?

Probiotics can…

• help rebalance your gut microbiome

• improve immune health

• reduce inflammation

• improve skin health

• reduce insulin resistance

• reduce antibiotic-associated diarrhea

• improve symptoms of IBS

• reduce symptoms of recurrent bacterial vaginosis

How do probiotics work?

When you take a probiotic supplement, the bacteria and yeast strains arrive in your intestinal tract and interact with your gut environment. Inside your gut is an intricate system of microbes, complex mucous layers, immune signaling and digestive processes.

Once the probiotic arrives in your intestines, it begins to interact with this complex internal environment.

Bacteria and yeast from the probiotic interact with your gut immune system called GALT (Gut-Associated Lymphoid Tissue), communicating with specific cells called dendritic cells and macrophages.

These bugs influence how certain immune cells develop and act within your gut lining.

Some strains of probiotics help to improve the integrity and strength of the gut barrier. Others will help restore balance to the community of flora, crowding out the harmful microbes and supporting the healthy ones.

Probiotics also aid in the breakdown and synthesis of certain nutrients, including fats, fiber, protein, vitamin K, and B vitamins.

Through their influence on all of these different factors, probiotic supplementation can begin to alleviate acute or chronic digestive symptoms, such as gas, bloating, abdominal pain, diarrhea and constipation.

How to choose a probiotic

1. Check the strains: Choose strains that match the symptoms you’re experiencing. For example, there is some evidence suggesting that certain strains of lactobacillus, like rhamnosus and acidophilus, are helpful in reducing the symptoms and occurrence of bacterial vaginosus (BV).

2. Check the CFU and dose: Effective probiotic doses typically start at 5 billion CFU per day and go up to 50 or even 100 billion CFU per day. More severe or acute digestive concerns may benefit from these higher doses. For most mild chronic symptoms, dosing between 5-50 billion is typical.

3. Check the diversity: depending on your goal, you may choose a single strain or a multi-strain product. But if your goal is overall gut healing and microbiome health, diversity is key. The more diverse your microbiome, the healthier your gut and immune system. Unless we are looking to use a certain strain at a high dose for a particular symptom, I am typically looking to prescribe a probiotic supplement with a large number of different strains.

4. Quality and third-party testing: Look for GMP manufacturing, third-party testing, and a clear shelf-life/expiration date. Storage instructions matter (some need refrigeration).

5. Ingredients: look for products that contain minimal additives. Avoid ingredients like titanium dioxide, maltodextrin, and artificial colors or flavors. If you have allergies or sensitivities, find the brands that say something like this brand is made without common allergens.

Fermented foods—an alternative to probiotic supplements

Fermented foods are like nature’s probiotic. Bacteria, yeast, and other microbes are naturally abundant within our environments, and they multiply during the fermentation process.

Including good quality fermented foods in your daily or weekly routine can support improve digestive function and support overall health and healing. You can find these foods at most grocery stores, or you can make them in your own kitchen. Hint: it’s really quite simple and not nearly as difficult as you’d expect. Check out my sauerkraut recipe if you’re not sure where to start.

Here is a list of common fermented foods

• Sauerkraut

• Kimchi

• Fermented veggies

• Yogurt

• Cottage cheese

• Kefir (made from dairy, coconut, cashew, water, etc.)

• Pickles (refrigerated)

• Miso

• Tempeh

• Sourdough bread

• Beet kvass

• Natto

• Apple cider vinegar

FAQs

• What is the best probiotic to take?

  There is no single best type of probiotic. Every person has unique needs. Look for probiotics with at least 5 billion CFU and clear quality standards.

• How quickly do probiotics start working?

  The benefits of probiotics will depend on why you’re taking them. For acute symptoms, probiotics can start to take effect in the first few days. For less severe and more chronic symptoms, expect to notice improvement over weeks to months.

• Do probiotics cause side effects?

  Some people will experience unwanted side effects like diarrhea, constipation, or other systemic symptoms. When this happens, it could be due to a number of reasons. The dose might be too high for you, or perhaps you need different strains.

  Probiotics can be triggering for individuals with mast cell activation syndrome or histamine intolerance.

  Sometimes probiotics will cause a “die-off” reaction as the beneficial strains crowd out the harmful or inflammatory strains. If this happens, work with a Naturopathic Doctor to find gut support that will work for you.

• How do I know if I need a probiotic?

  Most people can benefit from a probiotic. If you have a history of frequent antibiotic use, a probiotic may help restore a healthy microbiome. Probiotic supplements are a go-to treatment for many different digestive concerns.

• What can probiotics help with?

  Probiotics can relieve symptoms of IBS, gas and bloating, and inflammation. Evidence suggests probiotics may be useful in treatment for diabetes, arthritis, and mental health conditions like anxiety and depression.

Looking for personalized gut health recommendations?

Naturopathic medicine looks at you as a whole person—not just treating your symptoms. Probiotics can be a fantastic tool, but they aren’t the answer for everyone and they’re certainly not a cure-all. If you’re curious about this holistic, integrative, and individualized approach, click the button below. Dr. Savannah will be happy to talk with you about whether she’s a good fit.