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Choosing the Right Probiotic


Choosing the Right Probiotic

December 20, 2020

Teresa Esterle, M.D.

There are many considerations when choosing a probiotic. Generally speaking, most people can benefit from taking one. We always recommend working with your provider to get a specific recommendation that is best for you. However, there are three things you should be particularly concerned with:

1. Picking a Quality Brand

This is important, because many supplements do not actually contain what is on the label. In the United States, supplements are not regulated by the FDA, so many don’t have the amount of the ingredients that they claim, and a number contain non-listed ingredients including pharmaceuticals. Others are adulterated with heavy metals and pesticides.

For example, a study in 2016 of 16 probiotic supplements on the market showed that only ONE of the supplement’s ingredients perfectly matched its label. The others had additional bacterial strains not listed, and/or lower amounts of the listed strains than claimed. Different lots of the same probiotic often contained different amounts of bacterial strains, and sometimes even in the same bottle the number of strains was different from one pill to the next.

Another issue with probiotics is that many claim to have a certain number of colony-forming units, but then have the disclaimer that the amount listed is the amount present “at time of manufacture”. By the time the bottle makes it to your cupboard, there are often many fewer colonies present. It is better to pick a product that guarantees a certain number of CFU at the time of expiration—this means that you actually get more colonies than listed on the label if you use them before expiration.

Brands that we recommend (and sell in our store) include AIM for Wellbeing, Klaire, Metagenics, Orthomolecular, Microbiome Labs, Thorne, and Pure Encapsulations.

You can learn more about supplement quality in this blog post.

2. Picking some good strains.

Depending on your age, sex and symptoms, different probiotic strains may be more effective for you. For example, if you have yeast overgrowth, you want to pick a product with a friendly yeast strain like Saccharomyces Boulardii. If you are a woman prone to vaginal infections, certain Lactobacillus strains will be more helpful. And if you have histamine issues or SIBO, some strains can make your symptoms worse. Ask your doctor for advice on the best strains for you.

3. Deciding whether to use a shelf-stable product vs. a refrigerated one

Many probiotics are heat-stable— it all depends on the processing. Spore-based probiotics can withstand very high temperatures and are often more efficient at improving the microbiome even in relatively low doses. Recent studies show that these Bacillus strains of bacteria can increase levels of other good bacteria in the gut and decrease levels of bad bacteria. So instead of taking a supplement with a large number of colonies and large variety of strains, a small number of Bacillus bacteria can have the same or even better effect on the health of the GI tract.

Shelf-stable probiotics are best for frequent travelers, or people who have a hard time remembering to take supplements out of the refrigerator. For those who make smoothies every day, a refrigerated probiotic can be added to the smoothie—just break open the capsule and add to the mix!

At AIM, we continually evaluate the probiotics and supplements that we carry in our store and recommend to our patients.

Some of our favorite probiotics include:

People respond differently to probiotics, so you should closely monitor the way you feel after you start taking one. Many people will notice short term side effects, such as gas, bloating, or even diarrhea. These should decrease after a week or two of taking your probiotic and then you should notice some positive effects. For example, you may have more frequent or regular stools. Your energy and mood may improve. Skin rashes may clear up, and joints may be less achy. If you do not feel a benefit or have prolonged negative side effects, you should speak with your doctor about choosing a product that will work better for you.

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