Probiotics. We hear a lot about how we should be taking supplements of these because they’re great for your digestive system. But because supplements aren’t regulated by the FDA, how are you supposed to find the one that’s right for you and your patients?
Fear not. Dragana Skokovic-Sunjic, BScPhm, NCMP, is a Clinical Pharmacist with Hamilton Family Health Team, Hamilton, ON as well as a leader in the knowledge of probiotics both in the United States and Canada. In addition, Skokovic-Sunjic is the author of Clinical Guide to Probiotic Products Available in Canada and Clinical Guide to Probiotic Products Available in the US, both of which are updated annually.
She took the time to answer questions.
For those who don’t know, what are probiotics and how do they help our bodies?
Probiotics are tiny but powerful organisms that, when taken appropriately, can oﬀer substantial health benefits. While many people believe probiotics are for the gastrointestinal tract only, scientific evidence asserts far-reaching and diverse benefits of probiotics which extend far beyond the gut to include: respiratory ailments, mental health, colic in babies, weight management, vaginal health, and more.
Probiotics offer health benefits through several mechanisms: modulation of composition or activity of the microbiome, modulation of the immune system, effect on systemic metabolic responses, improving barrier function in the gut, and increasing colonization resistance against pathogens. Many other new benefits are being discovered every day with the new research. (Source: https://isappscience.org/for-scientists/resources)
There are so many on the market. How can people choose the best one for them?
Probiotics are potentially beneficial; however, it is important to note that the effects and benefits are strain-specific and disease-specific. One needs to know what to use and why. Taking any probiotic, or a probiotic with the best-looking label or best price does not necessarily mean it will provide the desired benefit. It would be similar to walking into the pharmacy and simply asking to be given medication.
Probiotics are similar to medicines. Each one is unique and has a particular intended purpose. Just as taking medication for pain won’t prevent pregnancy, taking a probiotic to prevent traveler’s diarrhea won’t relieve a baby’s colic symptoms. It is essential that probiotics be prescribed or selected, and taken, appropriately.
All probiotics are not created equal, nor is the science that validates their eﬀectiveness. Unlike medicines, probiotics are not strictly regulated yet. Unfortunately, this means there are many probiotic products on the shelves that make claims that are not substantiated by scientific evidence. This is confusing, frustrating, and is resulting in people wasting money buying the wrong probiotic for the condition they are suﬀering from.
Selecting the proper probiotic and taking it appropriately for the symptoms or condition you wish to relieve is imperative. Be informed when choosing a probiotic. The Clinical Guide to Probiotic Products Available in the US is the only comprehensive summary of probiotic brands that reviews, rates, and summarizes the scientific evidence available for specific probiotic strains and related brands.
Clinical studies supporting the recommendations made by our expert review board are all listed for those who would like to dig deeper and learn more. You can also use a free, quick-access app as your reference tool, by downloading the Probiotic Guide free app to your iPhone or Android smart phone. Make sure to select one for your region—one for the US and one for Canada. Both the website and app contain the same information, including the references, level of evidence, reasons for use, dosage formats, and more.
It is essential to know that not everyone needs to be taking a probiotic supplement. If you are eating a balanced diet, including fermented foods often, not taking antibiotics, and are generally healthy, you do not need to take a probiotic all the time. However, in some situations, such as the cold and flu season, you might look at the evidence for specific strains and products that seem to minimize the risk of common infections disease or shorten the duration of cold and flu.
Are there any things to watch out for?
Most importantly: read the label. The probiotic product you select must show the unique name of the probiotic you need to use on the label. The name is a combination of three critical elements: its genus, species, and strain. The strain is particularly important because it not only reﬂects the physical characteristics of the probiotic, but how it will act, interact, and react with your individual microbiome. Dose expressed in CFU (colony forming units) and potency at the time of expiry has to be clearly stated.
Like any other supplements, the label should provide a non-medicinal ingredients lists, such as traces of dairy, gluten, and other potentially harmful allergens.
Most probiotic strains available in the U.S. and Canada have been deemed safe (GRAS status or NPN designation) for the general population. For critically ill patients, severely immunocompromised patients, and other special circumstances, the use of probiotics can be done under strict medical supervision.
Is it best to take them with or without food? In the morning or evening?
Timing and the best ways to administer probiotics is again, very strain-specific. Generally, most commercially available products can be taken at any time of the day, with or without food. Some strains are available in liquid form (drops) and are very effective even in a dose of 0.5B (billion) CFU. Other probiotic strains need to be taken in an enteric-coated capsule in a dose of 50B CFU in order to survive through the acids present in the gut to reach the target areas and provide benefits. This does not mean one is better than the other: it merely illustrates that not all probiotics are the same.
How can people tell if the one they’ve chosen is working?
If the probiotic is working, you will know! And you will know very soon. The best approach is to identify the reason why you would take the probiotic. For example, you suffer from IBS and would like to try a probiotic. Faced with so many choices, you turn to the Probiotic Guide mobile app, and find a few options with the highest level of evidence.
At this point, you could consult your health care practitioner, or decide to give it a try. Most probiotic products are available without a prescription.
The next step is to take the selected probiotic as recommended in the Probiotic Guide or on the product label. After you achieve symptom relief, you can stop taking it and see what happens.
Quite a few of my patients with IBS do safely stop taking probiotics after the initial treatment while others may need to take the probiotic continuously.
The length of time one needs to stay on a probiotic may different for each individual and the reason the probiotic is taken. Once symptoms are gone, you can try to stop and see what happens.