How to Choose the Best Probiotic

Tagged in: Digestive Health

by Dr. Bryan Do, D.O. Last Updated: March 07, 2019

How to Choose the Best Probiotic Supplement

Probiotic supplements have become popular throughout the years because of their health benefits. However, in order to avoid side effects and enjoy these probiotic health benefits, one must understand what makes a good probiotic supplement.

Choosing a good probiotic can be complicated. CFUs, species, strains, multisyllabic probiotic names - these are all terms you will need to know to be an educated probiotic shopper. Thankfully with this handy guide you won't need a degree in microbiology to figure out what the best probiotic supplement is for you.

How to Choose a Probiotic

We've come up with a handy system to help you remember what to look for in a probiotic called "The Three D's."

The Three D's stand for Diversity, Dose, and Delivery.

1. Diversity of Probiotic Strains

If you looked inside your gut at all the bacteria you would notice that there are more organisms than there are people on the Earth. Each one of those organisms has carved out its own niche in your GI tract. This means that each one has a slightly different strategy of living inside your gut.

Some of these strains eat the sugars you eat, others thrive off of the fiber you eat. Each strain relies on a slightly different energy source and lives in a slightly different area of the gut. Some produce antibacterial compounds like lactic acid and others release compounds called bacteriocins to thwart off competitors.

The best microbiome (or probiotic environment) inside your gut is one that is diverse. Being diverse makes it more able to handle different kinds of threats and stressors.

For example, if you look at your community you have teachers, lawyers, engineers, mechanics, politicians. It would not make sense for all the people in your community to be mechanics. What if someone invented a new type of transportation method that rendered cars obsolete? The community made of entirely of mechanics would have their livelihoods threatened while a community made up of different professions would be able to adapt and change.

Shekkar Challa, President of Kansas Medical Clinic and author of Probiotics for Dummies, suggests taking a probiotic with multiple strains of bacteria because your gut contains at least 30 to 40 different kinds of probiotics. It would only make sense to supplement your body with as many different types of probiotics as possible. For example, have a look at the Supplement Facts label of DrFormulas' best selling probiotic Nexabiotic® Advanced:

Each line on the ingredients label is a different species of probiotic. Probiotics are named in the following manner: The first italicized name is the family name, and the second italicized name is the species name. For example, Lactobacillus acidophilus probiotics are probiotics of the acidophilus species which belong in the Lactobacillus family. Some labels will shorten the family name to just the first letter. For example, Lactobacillus acidophilus can shortened to L. acidophilus.

Comparing two different species within the same family is like comparing the wolf to the coyote. The wolf is named Canis lupus whereas the coyote is called Canis latrans. There are differences between both even though they are both a part of the Canis family.

Some specific probiotic strains you should keep an eye out for include:

Lactobacillus acidophilus – Widely considered one of the most researched and used probiotic strains, Lactobacillus acidophilus has been found to shorten the duration of pediatric diarrhea, support vaginal health, reducing E. coli, and supporting healthy cholesterol levels.^1-2
Lactobacillus rhamnosus – Naturally found in the human body and in dairy foods, Lactobacillus rhamnosus competes against bad bacteria using acid, bacteriocins, and hydrogen peroxide. Lactobacillus rhamnosus GG has been found to reduce diarrhea and respiratory issues in children.^3-4
Lactobacillus plantarum – Lactobacillus plantarum is unique for its potential to support the production of compounds that can eliminate harmful bacteria in the gut. plantarum competes against other bacteria and gram negative bacteria in the gut.^5-6
Lactobacillus reuteri – Strains of reuteri may promote oral, digestive, and vaginal health. L. reuteri reduces pro-inflammatory cytokines and produces an antimicrobial agent called reuterin.¹⁰
Bifidobacterium bifidum – Another bacterial strain that occurs naturally in your gut, Bifidobacterium bifidum helps reduce the acute diarrhea and are able to reduce inflammation in the gut.^7-8
Bifidobacterium longum – This strain may expedite the breakdown of proteins and carbohydrates to protect your intestinal wall. longum is beneficial to premature infants and help establish the desired normal intestinal flora. It reduces constipation, diarrhea, and can compete against bad bacteria like Campylobacter jejuni.⁹

What it boils down to is this: whichever probiotic you choose it should have a diverse number probiotics such as Lactobacillus, Bacillus, Saccharomyces boulardii probiotic yeast, Bifidobacteria, and Enterococcus.

DrFormulas Probiotics

2. Dosage > 10 Billion CFUs

Each probiotic comes with its own suggested dosage. Pick a probiotic that has at least 10 billion colony forming units (CFUs).

Why 10 billion? One meta study (or study of studies) found that a dose of 10 billion was needed to reduce the duration of diarrhea.

In microbiology, a colony forming unit, or CFU for short, is a unit used to estimate the ability of bacteria or fungal cells in a sample to multiply. It is a measure of how many organisms are present.

Normally supplements are measured in milligrams, a unit of weight, but since each probiotic weighs differently, the most accurate characterization of how much probiotic is in each capsule is by colony forming units.

The exact serving of probiotics that you need may vary based on your needs, but keep in mind that a small dose of any kind of drug or beneficial compound will simply be ineffective. Some probiotics will have a dose in the millions which is less effective than one having a dose in the billions. Other still will list their dose in milligrams of probiotic without stating how potent each milligram is. Sticking with at least 10 billion CFUs is a safe bet.

The good news is that probiotics are generally safe for healthy adults, though those with compromised immune systems should consult their doctors before starting probiotics. Those new to probiotics may experience some mild side effects, most commonly bloating, gas, diarrhea or constipation, and abdominal discomfort. As the beneficial bacteria populate the gut and grow, your body should adjust to the sudden influx of new bacteria, leading to improved digestion and GI health. Any side effects that you do experience should go away within the first few days after taking your probiotics.

If your side effects persist, consider reducing the dosage and working your way up to 10 billion CFUs. It’s also a good idea to take your probiotics at 30 minutes before your meal, which gives your probiotics a better chance of surviving the gastric acids and digestive process. If that doesn’t work, consider taking the probiotics before bed. You should also make sure to stay hydrated throughout the process.

So remember, when looking for the best probiotic supplement, make sure it has > 10 billion CFUs.

3. Stomach Acid Resistant Delivery

The stomach is the first organ encountered by things you eat or consume. It is full of acid and enzymes to help break down foods and initiate the digestive process. Your stomach acids are essential to your health and digestion. It breaks down foods into their smaller components, absorbs certain nutrients like vitamin B12, produces chemical signals to alert other parts of your digestive process, and eliminates potentially harmful bacteria, viruses, and fungi that may be in the food that you ingest. Unfortunately, your stomach acid does not have a means of differentiating between good and bad bacteria, so even probiotics can get killed if exposed to your gastric acids.¹¹

What good is taking a probiotic if it doesn't make it past the acid inside your stomach?

Some probiotic organisms can resist stomach acid such as Lactobacillus species, Bacillus species, and Saccharomyces boulardi. However not all of them are. Even if species are acid-resistant, not 100% of them will survive exposure to stomach acid.

Probiotics that come with a delayed release mechanism help to ensure that the probiotics inside reach the stomach and is dispersed in the gut, where they are most effective.

Delayed-release mechanisms come in a number of varieties.

Enteric coated capsules are normal capsules that are then sprayed with an acid resistant coat to delay the release of its contents. Be careful as some of these coatings contain pthalates that are known hormone disrupting chemicals.
Pearls with a stomach acid resistant outer layer. How these probiotics are made is that the probiotics are put inside a protective outer layer that is stomach acid resistant.
Stomach acid resistant delayed release capsules. These capsules are made of a material that is resistant to stomach acid and release their contents once they get to the gut.

In conclusion, remember "the three Ds" when picking out your probiotic. The best probiotic supplement has diversity (more than one name in the supplements facts), dose (CFU count > 10 billion), and delivery (some kind of delayed-release mechanism to ensure maximum availability of probiotics to the intestines).

Still have questions about probiotics? Check out our article on the most frequently ask questions about probiotics.

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About the Author:

Dr. Bryan Do, D.O.

Dr. Bryan Do, D.O. is an osteopathic physician whose research interests include gastroenterology, immunology, and dermatology. He is particularly interested in the role of probiotics in the gut-brain-skin axis and has written many articles on the topic. He graduated from University of California, Los Angeles (UCLA) before graduating from Marian University College of Osteopathic Medicine in Indianapolis, Indiana and becoming a Doctor of Osteopathic Medicine. Osteopathic physicians are taught to take a holistic approach to medicine and to consider mind, body, and spirit when treating a patient. Osteopathic physicians receive training in Osteopathic Manipulative Medicine (OMM) in addition to the standard rigorous medical school curriculum. Both physicians with a Doctor of Osteopathic Medicine (D.O.) degree as well as a Doctor of Medicine (M.D.) can practice medicine.

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