Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, Fourth Edition (33 page)

In addition to getting probiotics naturally from our food each day, they can be obtained by taking probiotic supplements. I am frequently asked about which probiotics to take, when to take them, and what type of dosage is required.

The many probiotic supplements on the market look similar but can be extremely different in their effectiveness. Consumer Lab tested 25 probiotic products. Eight of them contained less than 1 percent of the number of probiotic bacteria listed on the label. It is important to use well-researched probiotics that have been found useful in clinical settings. So how can you know which products are best? Always look for a batch number and expiration date. Purchase your products from a health professional or store where someone has done the research for you.

Typically I look for mixed probiotic supplements that contain Lactobacillus acidophilus plus Bifidobacteria strains. However, there are times when you may choose to use a specific strain or specific probiotic. For example, for chronic diarrhea, you may choose to use Saccharomyces boulardii by itself. If you are lactose intolerant, you may choose to buy a dairy-free probiotic. However, some people find that by using dairy-based probiotics they become more lactose tolerant. The best test is to try them out and see what your body likes best.

What Types of Microbes Am I Looking For?
Look for the normal gut flora such as lactobacilli and bifidobacteria. Supplements may also contain the species Lactobacillus casei, L. reuteri, Bifidobacteria longum, B. breve, L. lactis, L. rhamnosus, and others (see
Table 6.2
). Bifidobacteria infantis is the most appropriate choice for a newborn and is also useful for children and adults who have IBS.

More is being learned about specific strains of probiotics. Just as a poodle is not the same as an English setter, two strains of acidophilus or bifidobacteria can be very different. According to Natasha Trenev, an expert on probiotics, various strains of acidophilus can differ genetically by as much as 20 percent. This is a huge difference when you consider that the genetic difference between mice and man is about 2 percent.

Some supplements contain soil-based probiotics such as Bacillus laterosporus, B. subtilis, and L. sporonges (also known as B. coagulous), but research in peer-reviewed journals has yet to substantiate the many anecdotal stories of great success with these soil-based organisms. In fact, all of the literature seems to be about the disease potential of these bacteria. Therefore, I cannot recommend them at this point in time.

Viability and Potency.
Most probiotics supply between 1 billion and 25 billion organisms per dose, and a few supply substantially more, up to 450 billion. The number, however, isn’t the important thing, as some studies have shown supplements to be effective even when they contain only millions of organisms. What matters is whether the product contains living, viable organisms that adhere to the gut lining, are not destroyed by bile, and have benefit once in your body. Yet there is still much to be learned. Research indicates that even dead probiotics can have profound effects on the immune system.

Table 6.2
Bacteria and Yeast Used as Probiotics in Supplements and Food

Probiotics come in two main types: those that need refrigeration and those that don’t. I generally prefer the refrigerated varieties. These delicate bacteria must be
refrigerated in shipping, at the store, and in your home to ensure their life span and greatest potency. Probiotics will maintain potency at room temperature for short periods of time; for instance, if you are on vacation for a week or two you’ll probably lose a few percentages of potency. If you left them out for several months, they’d be dead. I personally put a week’s worth of probiotics in my supplement container so that I don’t forget to take them.

Bacteria multiply very quickly, but they need enough food and protection to survive the trip through the stomach and into the intestinal tract, so many probiotic supplements also contain prebiotics such as fructooligosaccharide (FOS) and inulin, which provide nourishment for the bacteria (see the section “Prebiotics” later in this chapter).

Look for Lactobacillus acidophilus and Bifidobacteria bifidum.

Choose an age-appropriate product. For a baby or toddler, B. infantis is appropriate; for children and adults, the most-studied strain of L. acidophilus is DDS-1.

Choose a product that is condition appropriate when it’s available. There are now supplements that are specific for lactose intolerance, sugar malabsorption, irritable bowel syndrome, and diarrhea. There may soon be other specific products for psoriasis, vaginal infections, inflammatory bowel disease, and other health conditions.

Most of the best products come refrigerated. There are some viable products on the market that are stored at room temperature.

Bacteria multiply very quickly, but they need enough food once they reach the intestines. Some products contain inulin, FOS, or other prebiotics that help the flora grow. This can vastly improve the viability of the product. Just note that some people bloat from FOS.

Combination supplements with several types of flora are helpful. Bacteria compete for the same food supply, so look for freeze-dried products. Freeze-drying puts the flora into suspended animation, keeping them dormant until placed in water or in your body.

For daily prevention take 1 billion to 25 billion organisms daily.

Therapeutic dosages vary depending on the severity of the condition. You may find 1 billion or 2 billion organisms daily keep you well and rebalance you. Other people may need 25 billion to 100 billion organisms, or more. After antibiotics, I typically recommend doses between 30 billion and 100 billion organisms daily.
Studies on people with ulcerative colitis have found benefit in dosages of more than 2 trillion microorganisms daily.

Begin taking the probiotics at a low level and increase the dose slowly. If you experience bloating, diarrhea, gas, or worsening of symptoms, stop taking your probiotics. As the disease-producing bacteria and fungus are killed, they release chemicals that aggravate symptoms. Begin again with tiny amounts and build up your dosage slowly to avoid the die-off reaction. Symptoms like this usually tip you off that what you are doing is correct; however, if that’s true, they begin to subside after a few days. Of course, if the symptoms continue, do go see a doctor.

Prebiotics are saccharide (sugar) molecules that play an important role in health maintenance. Prebiotics also nourish and stimulate the growth of “good” bacteria while promoting a reduction in disease-causing bacteria such as clostridia, klebsiella, and enterobacter. Prebiotics work synergistically with probiotics and can be taken together for best results (together, they are called synbiotics). You will often find them in your probiotic supplements. Like probiotics, they acidify the intestinal environment, enhancing the absorption of essential minerals.