Posted by Dr. Adam Killpartrick, DC CNS on Jan 4, 2019 2:05:00 PM
No two probiotics are the same—literally.
Because probiotic strains and brands vary widely, functional medicine practitioners will want to stop and read the fine print before deciding on a line of supplements and prescribing a regimen for patients.
A lot can be learned from the label, including whether the probiotic supplement is more generalized for gut health or aimed at more specific digestive health with targeted benefits, like vaginal health and digestive irregularities, how long to expect the probiotic to be effective, and whether its potency is high or low.
This probiotic primer will help you select the highest quality probiotics for each individual patient’s digestive needs.Shelf Life
Expiration dates are printed on all probiotic strain packaging.
Measured in CSU, an active strain number is typically noted at the time of manufacturing. During the product’s shelf life, a certain amount of active microorganisms will die off, especially as the product comes into contact with different environments, such as during shipping, storage, and sitting on the physical shelf.
The expiration date serves to guarantee the potency of the probiotic strains from the time of manufacturing up to the expiration date. After expiring, the strains may have lost enough live microorganisms that the product is less ineffective.
Many probiotics will also list the number of microorganisms in each capsule.
Typically numbering in the billions for probiotic strains, this number is an estimate per capsule that helps you identify a supplement’s potency. A lower-potency supplement will have as little as 5 billion microorganisms per capsule, while a higher-potency one will have as much as 50 billion. This number does not represent the quality of the strains, though.
Your patient’s individual needs and the stage of their digestive journey, not the number of microorganisms in the capsule, will influence the potency you recommend.
For example, if you want to support reinoculation and healthy flora you may want to proscribe high-potency probiotics for a month or two, then scale down to a lower-potency one to maintain gut wellness.
Probiotics also come in chewable form, with digestive enzymes blended into the formula. This may be the right option for your patient depending on their particular digestive situation. Some people do really well with chewable forms, because the digestive process begins sooner—when they’re chewing rather than later in the GI tract. If you are looking for a response that occurs earlier in the digestive process for a health reason or if the patient is new to probiotics, you may want to have them start with a chewable and a digestive. A high quality supplement line will offer a range of probiotics to choose from in order to provide the best option for your patient’s health holistically.
If your patient presents with a number of digestive issues that need attention, you’ll want to opt for a broad-based, full spectrum multi-strain probiotic that contains multiple active strains of microorganisms.
If a patient’s diet is low in fermented foods, if your goal is to help them normalize or regulate digestion, or if they’re traveling abroad and simply want to support digestive health, a general probiotic works well.
However, if you have a targeted goal in mind, there are newer precision probiotics that help support specific issues, such as a need for promoting healthy vaginal flora or supporting GI tract health.
In addition to verifying the quality of the live cultures on the label by noting potency at the time of expiration, paying attention to the quality of the raw materials is also important.
Some probiotics use dairy as a source of growing bacteria, but a brand that can boast a non-dairy supplement offers a higher quality product that’s suitable for a broader clientele.
Many patients experience dairy sensitivity in some form—whether through bloating or bowel irregularity—and giving them a probiotic made with dairy may conflict with the results you’re aiming for. The same goes for probiotics that contain whey protein versus vegan protein.
Five years ago, the functional medicine community would have stood behind the idea that the more live microorganisms you can pack into a capsule, the better the quality of the probiotic. It was all about concentration.
Now we understand that the quality of the strains themselves is really what determines the potency of a probiotic supplement. ID-provided strains backed by research studies have helped shift this understanding, and they can be useful to practitioners, too. Probiotics that have an ID number attached to them can be linked to a published study that shows the strain’s effectiveness. To find that research, simply search for the ID stamp assigned to the family strain associated with the product.
ID-provided strains can be informative, but you should do your own research on the supplement provider as well. Align your practice with a trusted brand that’s been around for a while, and produces reputable products that contain strains made from high quality raw materials. Keep in mind that concentration doesn’t necessarily equate with quality. The numbers and types of strains, along with their shelf life, are important things to consider. This will guide you to the best product that offers optimal digestion and nutrient absorption.
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