In this post, I write about how to choose a good probiotic, and list some brands you can think about in your search for the ideal probiotic supplement.

Interested in reading the peer-review, scientific literature on probiotics?

It can be intimidating, if you’ve not searched scientific studies before, to wade through the myriad studies out there on probiotics (or any topic for that matter). Probiotic-research.com has done a lot of the work for you. The site provides abstracts and links to studies involving probiotics and health. They even break it down by category (probiotic studies on immunity, H. pylori, infants and children, IBS, etc.).

You can sign up for RSS feeds and have summaries delivered to your feed reader or email. It doesn’t get any easier than that unless you get your own research assistant.

You can also check out the International Scientific Association for Probiotics and Prebiotics for more information on probiotics.

 Eating an Anti-inflammatory diet plus consuming beneficial bacteria are the key factors in restoring gut health.

Before I get on with the meat of the post, let me remind you quickly why we talk so much about probiotics in the natural health and healing realm.

Just a Few of the Benefits of Probiotics:

  • People with IBD, IBS, and other idiopathic conditions get better when they take them. Do we need any more reason than that?
  • They can produce natural antibiotic compounds which control the growth and proliferation of other (potentially more harmful) bacteria.
  • They can inhibit yeast.
  • They can decrease your chances of certain cancers (including colon cancer)
  • They can increase your energy levels, improve digestion, and increase nutrient availability.
  • They synthesize short-chain fatty acids, which are essential fuel for your gut mucosal lining, and for every other cell in your body.
  • They synthesize vitamins, like vitamin K, and many B vitamins.
  • They can have anti-inflammatory properties, and help ‘turn off’ the immune inflammatory response.

Oh, which way to go?

Probiotic manufacture: What is a good probiotic? How can I tell a good probiotic from the rest?

1.    Does the Strain Matter?

Note: I’ve done my best to fulfill this criterion for you in the brands I list below, but I’m sure there are more brands out there that meet this criterion; In listing a few, I will inevitably have missed some great brand that someone loves.

In short, yes, yes, and yes. You’ll have to do some homework on this one, but you want to pick a brand that uses strains that are proven beneficial in human studies. This is easier said than done. Most companies don’t label what strains they are using. They will give you the genus and species (for example, L. planetarium, or B. bifidum) but they won’t label the species (L. acidophilis DDS-1, for example).

Jini Patel Thompson, in her book, Listen to Your Gut, states that there are about 200 strains of L. acidophilis, but only 13 of them produce natural antibiotic compounds that help control the populations of other bacteria around them. Strain matters.

From the companies I’ve called, most won’t tell you the strain they are using. They claim it’s proprietary information. From where I sit now, I think that is a terrible excuse. The choice of strain in large part determines the efficacy of the probiotic, and there are no patents on strains, only trademarks on strain names, or patents on the manufacturing process. Maybe they won’t tell us the strain type because they don’t know…this has been the most frustrating part of writing this series, and of choosing a probiotic to use myself.

2.    Prove it!

Ideally, you want to choose a probiotic that has been studied, uses strains/species that have been studied, or has been used so broadly that it’s anecdotal evidence is overwhelming. The term “clinically proven” or something like it is a good place to start. If the company states that the product has been studied, read the studies, or call and request them. If the strains the company is using have been studied, make sure that the company is using them in the same doses that the studies used them.

3.    Quality and Quantity

Current good manufacturing practices (GMP) certification is a good place to start in finding a good probiotic. A GMP certification means that the company has adhered to a generally accepted protocol for quality management. You may have to call about this, as some companies follow GMP, but don’t put the stamp on their website.

Freeze dried, cold, live bacteria are best. Avoid filter or centrifuge extracted products as those extraction methods can damage bacteria and decrease the potency of the product.

Different bacteria have demonstrated effectiveness at different levels, so more CFU (Colony Forming Units) is not necessarily better. My rule of thumb is to have at least 1-2 billion CFU/serving of the bacteria for which I’m searching.

4.    Packaging

The three dangers for probiotic bacteria are light, heat, and moisture. Look for a probiotic that is continually refrigerated (maintains live bacterial counts), in the dark (either in brown glass, or an opaque container), and is free of moisture.

The only real way to keep bacteria completely free of moisture is to ship them in a sealed glass container. Certain plastics do allow some minimal amount of moisture to pass. Is it enough to significantly reduce the bacterial potency of the probiotic? I wish I could answer that for you. For now, just remember: though there are other methods, brown glass is the gold standard to keep out moisture.

Some people take issue with packaging multiple species together. I do not—so long as the species are not cultured together. Packaging multiple species together would be a problem if the species were grown together before being dried, as freeze-dried bacteria are inactive and unable to compete with each other. I explain more of my reasoning on this point in my previous post on single-strain versus multi-strain therapies.

5.    Avoid Prebiotics

You don’t need them in your body, and the bacteria, if they are packaged with their growing medium (freeze-dried bacteria will be packaged this way), don’t need prebiotic to thrive.

Prebiotic are polysaccharides and other substances that, if you are on the SCD or GAPS you can’t have anyway—they feed the ‘bad’ bacteria you are trying to replace.

Brands to Check Out:

(Note: These aren’t recommendations, though my preferences will inevitably come through below. I don’t get any compensation whatsoever for mentioning these brands.) Links to their sites are below in the cost table.

1.    Natren

Natren was the first manufacturer to hold an international GMP certification and continues to do so voluntarily. Their probiotics are pharmaceutical-grade, and they list the species and strain they use on the bottle. Their probiotics come in brown glass bottles, either in pill form or in powder. Natren uses 4 species (L. bulgaricus LB-51 [L. delbrueckii, subspecies bulgaricus]; B. bifidum Super Strain Mayloth; L. acidophilus Super Strain NAS or Super Strain DDS-1, and B. infantis Super Strain NLS). They are always grown separately, freeze dried, and packaged so that the species do not come in contact with each other (even in the pills!).

I have used these probiotics. I get them directly from natren.com and they ship overnight (expensive, but efficient) in cold containers. Shipping is Monday-Wednesday, last I checked. They are expensive, but of the highest quality.

2.    VSL#3

VSL#3 is manufactured by Sigma Tau Pharmaceuticals, and is also pharmaceutical grade. This is probably the best studied probiotic mixture of which I am aware. There are lots of peer-review, scientific studies that use VSL#3 for Crohn’s, Colitis, and IBS with positive results. These are also expensive, but of the highest quality.

I have called VSL#3 and asked for their strain mix, which is not listed on the label. They hold that as confidential business information, which is not surprising for a big pharmaceutical company. The preponderance of peer review evidence demonstrating the effectiveness of VSL#3 in IBD and IBS, however, is enough to override my concerns about not knowing the strains. It works, and they have studies to back them up.

 

VLS#3 uses 7 different bacteria and one beneficial yeast:

  • Lactobacillus casei
  • Lactobacillus plantarum
  • Lactobacillus acidophilus
  • Lactobacillus delbrueckii subsp bulgaricus
  • Bifidobacteria longum
  • Bifidobacteria breve
  • Bifidobacteria infantis
  • Streptococcus salivarius subsp thermophilus (yeast)

 

I have used VSL#3 too. The probiotic comes in a sachet (fancy word for pouch) of 450 billion CFU), in two different types of plastic. The absence of a moisture collecting device in the pouch leads me to believe that their packaging process, double-plastic foil-lined pouch, keeps moisture adequately at bay.

VSL#3 is freeze-dried with its medium and the strains are grown separately. You can get VSL#3 through the website or through a pharmacy. They have a lemon flavored sachet, but I recommend the unflavored, as flavorings can irritate those with IBD and IBS.

Even cooler, you can get VSL#3 DS (double strength), by prescription through your doctor and some insurance companies are beginning to pay for all or portions of VSL#3.

Drug Codes for VSL#3 DS:

NDC (National Drug Code) is 54482093001.

GCN (Generic Code Number) is 97109.

DIN (Drug Identification Number) is 00903105

 

If your insurance will not pay, Sigma Tau has a patient assistant program whereby if your annual household income is below 300% of the poverty line (for a family of five, that’s an annual household income of less than $78k), you can qualify for free VSL#3 DS for a year.

3. Custom Probiotics

10/6/11 addition: I’ve been using these probiotics now for about four weeks. I love them! The potency is super-high, and it’s the first probiotic that hasn’t made me itch all over. I noticed a difference in my gut symptoms after about five days using their 11-strain probiotic mix. Custom Probiotic both formulates and supplies high quality and potency probiotic dietary supplements for children and adults. The company was established in 1999 by Harry Bronozian, a chemist and a chemical engineer, who suffered from H. pylori and Candida.  He has healed himself using his custom formulations of probiotics.

They test the quality of their probiotics regularly, and know the room temperature potency shelf life of their product (about two weeks, before it loses significant potency).

Their website is also a good resource for recent developments from academia and industry regarding the use and health benefits of probiotics.

Their products are being used by patients with IBD, IBS, Candida, Autism, Lyme and other digestive related problems, reportedly with great success. Their formulations are being recommended by Medical Doctors, Nutritionists, Dieticians, Naturopathic Doctors, Chiropractors, and Pharmacists. They ship locally, nationally and internationally.

4.    Dr. Ohhira

I have not used Dr. Ohhira’s probiotics, but I know people have good luck with them, and some naturopaths use them. I would not recommend them for IBD for two reasons: (1) They have too many additives. See the ingredients list here. (2) They use prebiotics.

I left them in here because they use E. faecalis TH, which is an unusual and especially potent friendly bacterium.

5.    RenewLife

I have not tried these, but I know people who like them. RenewLife probiotics are easy to find, they are sold in many different types of stores. They were developed by Brenda Watson, a digestive care expert.

RenewLife probiotics are freeze-dried in an enteric coated (direct delivery past the stomach to the intestines), vegetable capsule with no additives (this is great for IBD). They guarantee delivery potency until the expiration date. Their product is stable to 73 degrees Fahrenheit, though they last longer if you keep them in the fridge.

Their Ultimate Flora, Critical Colon formula is the best for IBD, and uses 14 species. They even list some of the strains, but claim the rest are confidential business information. They use no chemicals in the growing, freeze drying, and packaging process. The product comes in a dark plastic bottle.

The company also offers a 60-day money back guarantee. Return it if you don’t like it; even open bottles.

5. Garden of Life, Primal Defense:

Ironically, I can’t write much about this one right now, even though I would have liked to have done so, given it was the brand that started this series. In 2006, the FTC filed a complaint against Garden of Life for making false claims about their products. (Oops.) You can find the FTC summary here.

Since I don’t know the status of the claim, I cannot in good conscience write a positive review of Primal Defense, or any Garden of Life product right now. There are other reasons, too, that this product falls last on my list:

1.  It has additives that I couldn’t figure out (What are ionic plant-based minerals? Which minerals are added? In what form?).

2.  It lists S. bouldarii first. If they follow labeling conventions of listing the most prevalent ingredient (by weight) first, then this product has more yeast (and wheat/barley grass) than real probiotic bacteria, like Lactobacillius. At the least, people with IBD need to be careful with yeast. So caution wins the day here.

A Quick Cost Comparison:

I did some back-of-the-envelope math to see what the relative prices per billion CFU (colony forming units) were for each of the above brands. You can do the same math for your favorite brand. I’ve rounded the price to the nearest U.S. dollar.

 

Brand ~Price/Bottle ($USD) Billion CFU/serving Price per billion CFU
VSL#3 $86.00/30 powder pouches 1 pouch = 450 b CFU $0.0064
VSL#3 capsules $50/60 caps 1 cap = 225 b CFU $0.0037
Natren Healthy Trinity Caps $150.00/90 pills 1 Pill = 30 b CFU $0.06
Natren Powder $30.00/2.5 oz. dairy 1 Serv. = 2 b CFU $0.30
Dr. Ohhira $39.00/60 pills 1 pill = 0.9 b CFU $0.72
RenewLife Ultimate Flora, Critical Colon[i] $50.00/30 caps 1 cap = 80 b CFU $0.02

 

Remember:

Eating an Anti-Inflammatory Diet plus Consuming Beneficial Bacteria are the Key Factors in Restoring Gut Health.

Dr. Art Ayers, from Cooling Inflammation writes: “A damaged or simplified gut flora can be fixed by eating foods that supply nutrients for the body

[snip]

“It is also necessary to eat the missing bacteria. Just adding a few probiotics with yogurt will not fix the problem…Fermented foods, especially those based on bacteria from your own home and garden, are good sources of health-providing bacteria. Raw vegetables will also provide bacteria that may be useful in your gut flora, as long as the vegetables are not too thoroughly washed. Sterilizing and cooking vegetables may avoid rare pathogens, but will certainly prevent contributions to a healthy gut flora.”

 

In my next probiotic post, I’ll look at other ways of introducing helpful bacteria into your diet. I will discuss easy, SCD friendly, dairy and non-dairy ways to consume oodles of healthy bacteria. Until then,

 

Onward to health.



[i] To my knowledge, this is the same probiotic as Ultimate FloraMax™ Critical Colon. It’s the same company, same person (Brenda Watson), and same species/strain mix (they’re even listed in the same order on the bottle). This one is marketed towards clinicians; same pill, new marketing jargon.

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