As an anti-inflammatory, gut health-focused dietitian, I talk about probiotics all the time. Yet amazingly, when I looked through my posts, I hadn’t really covered how to choose a probiotic supplement!
The reason for this is that I typically just share my two top probiotics picks (more on that later), but I really feel that it’s important to walk you through how to make this decision for yourself. Both, so you can see how seriously I take my recommendations…but also, so you can assess new products that come to the market, or how to make a choice where my fave products aren’t available.
What to Look for When Buying a Probiotic
Probiotics are so different from other supplements because they are actual living organisms, either bacteria or yeasts. They aren’t like vitamin D, which can just sit on the shelf forever.
So you want to ensure that a few standard criteria are met:
- The product is refrigerated unless it specifically states that no refrigeration is necessary. Even then, you might want to opt for a refrigerated product.
Bacteria are alive…and at room temperature, they will die off faster than if they are refrigerated, which slows their life cycle. Some products are truly shelf stable, which means they are manufactured in way that keeps the bacteria alive at room temperatures. However, whether or not you want to buy a shelf stable product depends on a big IF….
- The CFU (colony forming unit) count is guaranteed until the expiry date.
You wouldn’t believe how many ways there are to dog this system. Most commonly, by guaranteeing the CFU count (the number of bacteria) at manufacture, and providing an expiry date, but not telling you how many of those bacteria are still alive at expiry. For example, say a product has been shown to be effective at 100 million or 1 billion CFU, and they guarantee 1 billion at manufacture. But, by the time that product expires in two years, there are only 10 million left…so that product isn’t going to work for you. Think that doesn’t happen? One of the most popular probiotics on the market does just that.
- The product is enteric coated so your gut doesn’t destroy it.
You want the bacteria to get to your colon, which is where most of the bacterial party happens. However, your acidic stomach acid, followed by the alkaline digestive juices in the small intestine, do a really good job of killing off bacteria. So, an enteric coated product ensures that the bacteria are delivered to where they need to go. The coating resists the acidic pH and dissolves at a pH that is safe for the bacteria inside.
There are a couple of exceptions to this rule: a fresh, live product where the bacteria have not been freeze dried, or a few freeze dried products where the research confirms that the non-enteric coated product works, often because it comes in very high dosages that help account for that die off effect.
- The product has been used in at least one human clinical trial to verify its effectiveness.
A probiotic can have the slickest marketing on the planet, but if they haven’t invested in human clinical trials, whether or not it works is theoretical. Which is not the same as saying it definitely won’t work. It’s just that when I am making recommendations to you here, or in my practice, I’m not going to take a chance on a probiotic if I’m not sure it works.
So, if you want (and can afford) to roll the dice, and the probiotic seems to hold up on all other criteria, go for it. Give it four weeks. If it is working for you, you will feel a difference after four weeks (usually sooner). If you feel it, continue for at least eight more weeks to see if it improves your condition. If not, try another one.
That’s the crazy thing about probiotics: if they are working for you, you will feel it. You’ll get less constipated, or your irritable bowel syndrome or arthritis symptoms will lessen. A probiotic usually can’t do 100% of the job on its own…you’ll need good nutrition and lifestyle too…but you’ll feel a real shift.
Now, let’s talk some probiotic FAQs…
Is a Higher CFU Count Always Better?
In a word, no. More bacteria isn’t always better, or more effective. Which is important to know, because we are starting to see companies play a numbers game. But 100 billion of a bad probiotic won’t help you.
In the research, it appears that 10 billion CFU is a kind of average/minimum for effectiveness. However, there are exceptions to this, where evidence-based probiotics have been found to work at lower doses.
Each product will have its own specific CFU count that is its effective dose, and that dosage should be based on actual research…not just what sounds good on the front of the package. The way to know? Check the brand’s website to see if they link to studies that show if the product works at the dosage they sell.
So, if you have a probiotic you like, and then another one comes out with double the CFU, don’t assume it’s going to be better.
Are More Probiotic Strains Better?
This is another numbers game. A strain is the individual bacterium within a species. For example, most people think that acidophilus is one bacterium, or strain…but it’s a species, like human beings are.
So, there are many different strains of acidophilus – some great, some less so. The strains should be listed with their full name on the label, such as Lactobacillus acidophilus CL1285.
You’ll often see the very lazy argument that since your own gut flora is super diverse, a single strain couldn’t possibly work…and that more strains means a more diverse product that will work better. But nope. There are single strain products that are excellent, and multi-strain products that are garbage. Just give the good bacteria in a high enough dosage, and they’ll do their job.
Another potential issue with multi-strain probiotics is that since bacteria compete with each other, if the probiotic hasn’t been properly tested, you could be buying a ten strain product that in reality, has one or two strains that outcompete all the rest…and you’re really not getting what you paid for.
Instead, focus on ensuring that the probiotic actually works, which you can verify by using the criteria I just talked about above.
How do I choose the right probiotic for constipation, irritable bowel syndrome, or….?
This is a way less clear cut question than you might expect. The reason for this, is that not all probiotics have been tested for all conditions. Why? Research is damn expensive. Which is also why many brands that make probiotics don’t bother to do it at all (really!).
So, in an ideal situation, there is an evidence-based probiotic that has been tested for your unique concern. In the absence of that, choose an evidence-based probiotic that has been tested for other concerns. For example, if you have celiac disease, there is no celiac disease specific probiotic. But there are probiotics for IBS and Ulcerative Colitis, so try one of those.
Eventually, I expect that we will see a future where there are individualized probiotics for your unique concerns…but we aren’t there yet. Not even close.
Whew! So, you can see how much thought goes into selecting a probiotic – and this is just the high level overview. I don’t know about you, but doing the research on which probiotic is best is not often realistic for a lot of people. So how do you make this decision easier?
The Easiest Way to Find the Top Rated Probiotics
My favourite tool for selecting a probiotic, if you live in Canada or the US, is called Probiotic Chart. Each year, they independently review all of the probiotics on the market to assess the level of evidence and serve it up in a fairly easy to read chart. I recommend you take a peek at what is available and if you can, stick to the products with level I or II evidence.
Desiree’s Top Rated Probiotics
And finally, if you just want to know what I use, you can give one of my favourite probiotics a try: Bio-K+ or Visbiome. Both are excellent, well-researched probiotics made by companies that focus only on probiotics.
Bio-K+ is Canadian made, gluten free and comes in both a fresh drinkable product (dairy and vegan) and an enteric coated vegan capsule.
Visbiome is USA made, gluten free and comes in vegetarian (non-vegan, contains dairy) sachet and capsules. If you’ve been following me for a while, you know that I used to recommend VSL#3. I now recommend Visbiome, which is the true VSL#3 formula, which you can read more about here.
Disclosure: This is not a sponsored post, however, I am a paid spokesperson for Bio-K+ Probiotics. I strongly recommend both these brands, based on research and results in my clinical practice, and stand behind my recommendations.