Food & Fitness After 50: Clearing the Confusion on Probiotic Supplements

A friend asked a simple question, “should I take a probiotic supplement?” I wish there was a simple “yes” or “no” answer, as I’m sure that is what she wanted. But, as with many questions in nutrition, the answer is it depends. It depends on:

• What is the reason for taking a probiotic supplement?
• Is there a specific health problem that you are trying to alleviate by taking a probiotic supplement?
• What dietary sources of probiotics are you consuming? And, is your diet rich in not only probiotics, but prebiotics and dietary fiber? Diets high in fat, sugar, and excess alcohol do not promote the good bacteria in our guts, while a diet rich in fiber, fruits, vegetables, pro-and prebiotics contribute to a healthy balance of bacteria in our guts. (For more information on dietary sources of pre-and probiotics, click here and here.)

I had the chance to ask Dr. Anthony Thomas, Director of Scientific Affairs for Jarrow Formulas* to help us  navigate the landscape on probiotic supplements. First, let’s understand that probiotics won’t completely alter your gut microbiome because “probiotics do not sustainably colonize the adult gut, but should be thought of as temporary, transient residents that interact with the body and its microbial ecosystem to influence function and health,” according to Dr. Thomas.

Let’s start with the definition of probiotics:

• “Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” (WHO/FAO definition).

The key words in that sentence, according to Dr. Thomas are live when administered, adequate amounts, and health benefit.

He explained that the probiotic has to be live when you take it. How do you know? “Choose products that include the “Best Used Before Date” date and avoid products that declare potency “at time of manufacture,” as this measurement does not reflect the amount still alive when purchased and consumed. A transparent, quality manufacturer lists the guaranteed minimum number of live cells, measured in CFUs, per serving when stored as recommended and used prior to the “best used before date.” Dr. Thomas goes on to explain that while probiotics don’t really expire, but the number of live cells may not meet label claims if not stored as stated on the label and used beyond that date. The “time at manufacture” almost certainly over represents the quantity of live cells because the normal manufacturing process results in some die-off of live probiotics.

Adequate amounts mean not only quantity of probiotics in a supplement, but quality. “Probiotics are strain, dose, and condition specific.” Strains should be designated on a supplement label, so you know what you are getting. Dr. Thomas explains, “not all strains perform equally, and more strains are not better, better strains are better.” For example, if looking for a supplement to help with bowel issues, Lactobacillus (genus) plantarum (species) 229v (strain) is clinically proven to reduce bowel discomfort at dosing of 10 to 20 billion live cells daily.” The probiotic identification chart illustrates the difference between genus, species, and strain in a way that is understandable to those of us who might have forgotten what we learned in biology!

And, that leads us to the last part of the definition, health benefits. A probiotic must be studied to know if it conveys a health benefit. If a label simply says something like 40 billion CFU with 16 probiotic strains, it may or may not be clinically relevant. “Don’t be swayed by a large number of colony forming units (CFUs is how probiotics are measured). What you really want is the right strain in the right amounts,” says Dr. Thomas.

There are a lot of resources to help consumers know if a probiotic meets the definition from the International Scientific Association of Probiotics and Prebiotics (ISAPP). It takes some homework to take the guess work out, but if you are going to pay good money for a supplement, isn’t it worth knowing that it has evidence to support it will do what you want it to do?

I think this statement from the ISAPP sums up what we know, “probiotics are not a “cure all” and it is not necessary to take them to be healthy. But they may help you even if you are generally healthy. Probiotics will have different benefits – look for a product with studies that support the benefit you want.”

Dr. Thomas cautions us to be aware of “disingenuous marketing masquerading as education” for some probiotic supplements. A product claiming to be “ancient” might sound impressive, but if the product doesn’t list the strains, 100 billion CFUs per serving is meaningless.

Resources:

To learn more about a specific supplement check out the Clinical Guide to Probiotic Produces Available in the USA to help you understand the evidence supporting a probiotic supplement.

And, here is a link to helpful infographics on probiotics from ISAPP.

*I heard Dr. Thomas speak at a sponsored food and nutrition conference, but I was neither asked nor compensated to write this post.