How should I choose a probiotic supplement?

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Eva B. Cwynar, MD
Internal Medicine
Choosing a probiotic supplement can be tricky because there are many different strains and many different dosages on the market. When you're looking for a good probiotics, be sure to check the label. It should identify the strain of bacteria contained in the product and how many bacteria, or colony-forming units (CFUs), there are in each recommended dose. The two most common strains you will find are Lactobacillus and Bifodabacterium, which includes the best-known L. acidophilus strain.

Probiotics come in many forms, including chewable tablets, capsules, powders, liquids, and foods such as yogurt and dairy drinks. Most experts agree that the form you take doesn't matter as long as there are enough live organisms to begin growing in the intestine. Unfortunately, experts do not agree on the effective dose, and numbers vary widely from 50 million to as many as 1 trillion live cells per dose. Unless you're getting diarrhea or abdominal pain, I believe that taking more probiotic is more beneficial than taking less. According to the World Health Organization, probiotics packaging should contain the following information:
  • Strain: What probiotic is inside
  • CFU: How many live microorganisms are in each serving
  • Expiration date: Probiotics are not very effective past the expiration date
  • Suggested serving size: How much you take
  • Proper storage conditions: Does it need to be refrigerated? Kept at room temperature?
  • Corporate contact information: Where can you go for more information
There is no standard labeling requirement to make it easier to choose a probiotic product. The word probiotic on the label is not enough information to tell whether a given product will be effective for a particular health concern. As of now there is no consistent way to tell if you're buying the most effective product for the problem you're looking to solve. The best answer at this time is probably to consult with your health professional to find which product(s) he or she recommends.
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Ms. Ashley Koff, RD
Nutrition & Dietetics
A word on probiotics in supplement form: they are not all created equal. The type of probiotic, "strain specificity," is critical when it comes to the selection of a probiotic supplement to address a health issue. Clinical research, as well as anecdotal reports from practitioners, helps to validate which strains demonstrate greater effectiveness than others. For example, B. Infantis is one of a few strains found to improve some symptoms of irritable bowel syndrome. Some strains of L. bulgaricus have been shown to aid in lowering cholesterol.

Additionally, supplements, absent government oversight of probiotic production may not contain what they say they do, or the bacteria may not be alive at the time you take the supplement despite it being packaged alive (probiotics are very heat sensitive which is why most require refrigeration).
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Whether you're visiting the drug store, grocery or natural food shop you'll likely find an aisle where there are jars and bottles of things for you to put in your body that are neither foods nor medicines. Ranging from vitamins an...

d minerals to fiber and herbal remedies, these supplements are not regulated in the same way as either food or medicine. Some of them are backed by solid research, others are folk remedies or proprietary cures. If your diet does not include enough of certain vitamins or minerals, a supplement may be a good idea. Natural treatment for conditions like constipation may be effective. But because these substances are unregulated, it is always a good idea to educate yourself about the products and to use common sense when taking them. This is even more true if you are pregnant or taking a medicine that may be affected by supplements.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.