How to Choose the Right Probiotic

OCTOBER 21, 2015
There has been a lot of talk about all of the amazing things probiotics can offer, from weight loss, to lower cholesterol, to reduced intestinal discomfort.
 
Because the mass media refers to them collectively as probiotics, patients are given the impression that a single product can do all of these amazing things. But the fact is that probiotics are actually hundreds of uniquely different bacteria that are not interchangeable.
 
Just because a clinical study found that one bacterium or combination of bacteria had a specific action doesn't mean that all bacteria can perform that function. It just means that these specific bacteria performed that specific action in a specific population at a specific dose.
 
It is significant to note where in the world the study was conducted because healthy bacteria in Mexico or Japan are not the same as those seen in the United States. The bacteria we co-evolved with are unique to us and essential to our health.
 
The most commonly used probiotic is Lactobacillus acidophilus, but there are thousands of strains of these bacteria and they are not interchangeable.
 
Some L. acidophilus excrete lactic acid and therefore change the pH of the environment, making it unfavorable for bad bacteria. Other L. acidophlius work by simply competing with bad bacteria for living space and therefore keep them low in numbers.
 
This is why it is paramount that probiotics are alive at the point of action. Dead probiotics do not work.
 
Vaccines are dead bacteria parts, but probioitics are not vaccines. Probiotics need to be alive and in high numbers.
 
Therefore, pharmacists should urge their patients to be diligent about looking at the expiration dates on probiotic products. If the expiration date is approaching, then the percentage of live bacteria is not optimal.
 
Many clinicial studies looking at probiotics were conducted at various doses of live probiotics—ranging from 1.6 billion, to 10 billion, to even 100 billion colonies—and only the highest doses yielded favorable results. It is imperative for patients to read the manufacturer’s recommend dose and adhere to it.
 
Frozen yogurt and frozen kefir are probably not going to work for a yeast infection or diarrhea. Once the yogurt or kefir is frozen, the bacteria die.
 
However, modern technology can freeze-dry bacteria and put them into pill forms. In addition, some bacteria exist in spore forms and are temporarily inert to harsh environmental changes. Nevertheless, freezing probiotic yogurt at home is not recommended.
 
Common reasons for taking probiotics Clinical evidence
Strengthened immune system Children ages 1 to 6 who attend daycare centers seem to get fewer and less severe lung infections when given milk containing Lactobacillus rhamnosus GG or a specific combination product containing both Lactobacillus acidophilus and Bifidobacterium (HOWARU Protect).
 
Some research suggests that taking a specific combination product containing L. acidophilus and Bifidobacterium (HOWARU Protect) with milk helps reduce symptoms of fever, cough, and runny nose, and also decreases the amount of antibiotics needed in children. It may also shorten how long children have symptoms and decrease the number of days missed from daycare.

Consuming food containing B. longum BB536 for 3 weeks before getting a flu shot and 14 weeks thereafter seems to help prevent the flu in elderly patients.
Diarrhea Research shows that Saccharomyces boulardii can prevent diarrhea in patients with feeding tubes and also help treat diarrhea in infants and children. In addition, it may prevent diarrhea caused by taking antibiotics.
 
For hospitalized adults, drinking a specific beverage containing L. casei, L. bulgaricus, and Streptococcus thermophilus (Actimel, Danone) twice a day during antibiotic treatment and for 1 week thereafter significantly decreases the risk of developing diarrhea.
 
Giving children L. GG (Culturelle) along with antibiotics seems to reduce the diarrhea that they sometimes experience when taking antibiotics alone.
 
Taking a specific strain of L. rhamnosus or L. GG (Culturelle) seems to help prevent traveler’s diarrhea, which caused by bacteria, viruses, or parasites that the traveler has not been exposed to before. The effectiveness of L. GG can vary depending on the travel destination due to differences in bacteria in different locations.
 
The chemotherapy drug 5-fluorouracil can cause severe diarrhea and other gastrointestinal (GI) side effects. There is some evidence that patients with colon or rectum cancer have less severe diarrhea, less stomach discomfort, shorter hospital care, and require fewer chemotherapy dose reductions due to GI side effects when they take a particular strain of L. rhamnosus or L. GG (Culturelle).
Women’s health There is evidence that taking Lactobacillus by mouth or eating yogurt enriched with it doesn’t prevent vaginal yeast infections after an antibiotic regimen. However, women with yeast infections who use vaginal suppositories containing 1 billion live L. GG bacteria twice daily for 7 days in combination with conventional treatment often report that their symptoms improve.
 
Clinical research shows certain strains of Lactobacillus may help treat bacterial vaginosis when applied inside the vagina. Researchers have found that L. acidophilus suppositories (Vivag, Pharma Vinci A/S, Denmark) and vaginal tablets (Gynoflor, Medinova, Switzerland) may be effective.
 
Researchers also found that vaginal capsules with L. gasseri and L. rhamnosus seem to lengthen the time between infections.
 
There is some preliminary evidence that vaginal use of some Lactobacillus species might be helpful for preventing urinary tract infections (UTIs), but not all studies have agreed.
Weight loss Adults who consumed 3 servings of fat-free yogurt a day as part of a reduced-calorie diet lost 22% more weight and 61% more body fat than those who simply cut calories.
 
There are no commercially available pills or liquids on the market that have been specifically proven effective in the medical literature. However, 3 Japanese studies and 1 Canadian study yielded moderate results (3 lb to 10 lb weight loss after 12 weeks).
 
Many products claim to offer weight loss, but none of these claims have been connected with a clinical study.
Lower cholesterol It is interesting that probiotics can lower cholesterol, but they are not effective enough to use as treatment.
 
Early research suggests that consuming milk containing L. acidophilus 145 and B. longum BB536 reduces “bad” low-density lipoprotein cholesterol (LDLC) in patients with high cholesterol, though it also seems to reduce “good” high-density lipoprotein cholesterol (HDLC).
Allergic disorders A combination of freeze-dried L. rhamnosus and L. reuteri seems to reduce eczema symptoms in children ages 1 to 13.
Acne Some research suggests that taking a type of Saccharomyces boulardii (Perenterol, Cell Tech Phama) by mouth can improve the appearance of acne.
Constipation Some early research shows that taking a specific B. breve product (Yakult Co, Japan) can reduce constipation in children ages 3 to 16. Also, most research shows that mixing B. longum BB536 with milk or yogurt and taking the mixture daily for 2 weeks increases the number of bowel movements in adults who are prone to constipation.
 
However, taking this same strain of Bifidobacterium for 16 weeks does not seem to reduce constipation in elderly adults receiving nutrition through a feeding tube.
Irritable bowel and bloating Taking B. infantis 35624 (Align or Bifantis, Proctor & Gamble) for 8 weeks seems to reduce symptoms of irritable bowel syndrome (IBS). However, it does not seem to increase bowel movements.
 
Taking a specific product containing species of Bifidobacterium, Lactobacillus, and Streptococcus (VSL#3) seems to decrease bloating in patients with IBS.
Prevent pouchitis, an infection of the intestines after surgery Taking a specific product containing a combination of Bifidobacterium, Lactobacillus, and Streptococcus (VSL#3) by mouth seems to help prevent pouchitis after surgery for ulcerative colitis. Continuous treatment for 1 year seems to help most patients.
Ulcerative colitis Research suggests that taking specific products containing a combination of Bifidobacterium, Lactobacillus, and Streptococcus (VSL#3) or B. breve, B. bifidum, and L. acidophilus (Yakult Co., Japan) helps control symptoms and prevent their recurrence in patients with ulcerative colitis.
 
References: Medline Plus, Consumer Labs, Pharmacists Letter, WebMD.

Gunda Siska, PharmD
Gunda Siska, PharmD
Gunda Siska, PharmD, has worked in various fields within the pharmaceutical industry as a licensed pharmacist for more than 20 years. She is currently a staff hospital pharmacist assisting nurses and doctors with drug prescribing, administration, and dispensing, as well as independently monitoring and dosing highly toxic and dangerous drugs. For 2 years, she was concurrently a consultant pharmacist for skilled nursing facilities and nursing homes. Dr. Siska is a member of the New Mexico Society of Health-System Pharmacists and the American Academy of Anti-Aging Medicine. Follow her on Twitter @GundaSiska
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