The Latest on Probiotics in 2020 - Health Benefits of Probiotic Supplements, Uses, Brand Reviews

What are probiotics?

The official definition of probiotics is a “live microorganism which when administered in adequate amounts confer a health benefit on the host”. However, the use of the word probiotics is hardly regulated which can be confusing for consumers.

An important distinction to note also is a source of probiotic vs. added probiotics. With consumers now understanding the benefits of probiotics, food manufacturers are now adding probiotics to many foods like drinks, cereals, energy bars and even chips, but this does not mean these foods can be a functional source of probiotics. Just like how manufacturers cannot claim “a source of Vitamin C” if they add ascorbic acid (a form of Vitamin C) to preserve the food.

 Probiotics should further be broken down into its three parts : genus, species and strain.

 Let’s take a common probiotic, Lactobacillus Acidophilus as an example.

Lactobacillus = genus
Acidophilus = species
HA122 - strain*

*there are many types of strains and it is hard to understand the benefits of every strain as the research is vast and ongoing.

I like to explain this by comparing it to our names.

Example: 
The genus is your family name
The species is your given name
The strain is your personality or character. It’s what makes you, you.

Other names of probiotics that you will see are :

• friendly bacteria
• gut flora
• microflora
• good bacteria
• friendly microorganisms

What are the health benefits of probiotics? 

Dr Udo Erasmus places probiotics as one of the 14 basic components of health.
“They are as important as the other 13, which include greens, minerals, vitamins, essential fatty acids (from good oils), essential amino acids (from protein), fiber, digestive enzymes, antioxidants, phytonutrients, water, oxygen, light, and fuel."

Each of these 14 components of health must be present for optimum health to be possible. No component can substitute for any other.”

 Both strain and species can provide us with insights into how the probiotic can benefit us. The probiotic species can give us broad spectrum insights and the specific strain can take us deeper into specific mechanisms and benefits the probiotic can have on our complex system. For general health and conditions it is helpful to understand the benefit of the species without having to get into the science of the strains. 

Why do I need a probiotic? 

1. Here are my top 4 reasons why I always recommend a probiotic supplement:
2. 70% of our immune cells live inside our gut
3. we are overloaded with toxins, chemicals and pathogens
4. our food system is severely void of nutrients and healthy bacteria
5. There are more bacteria than the number of cells in our body. We better take good care of them.

In conclusion, all people of all ages would experience health benefits from a probiotic supplement.

Can we rely on fermented foods?

Fermented foods are great, but there are several issues that arise with foods like yogurt, kimchi, kombucha and sauerkraut:

1. some people are lactose intolerant and cannot take dairy
2. some people get bloating from cabbage in sauerkraut and kimchi
3. there are a lot of other ‘added ingredients’ in kimchi and sauerkraut that also make it high in sodium
4. the sugar added to these ferments, particularly to kombucha may not have fermented fully and so you are left with a sugar drink
5. you are not guaranteed the probiotic species, strain or strength in any foods
6. the bacteria would have likely been killed off during the heating process. This is particularly true with yogurt where all dairy needs to be pasteurized (heated to kill off bacteria).
7. you are not guaranteed that it will survive your stomach acid and reach your intestinal tract.

Introduction of Genus, Species and Strains

Let’s take a common probiotic, Lactobacillus Acidophilus as an example.

• Lactobacillus = genus
• Acidophilus = species
• HA122 = strain*

*there are many types of strains and it is hard to understand the benefits of every strain as the research is vast and ongoing.

I like to explain this by comparing it to our names:

• family name = genus,
• given name = species
• personality or character = strain

Speicies VS. Strains

Both strain and species can provide us with insights into how the probiotic can benefit us.

The probiotic species can give us broad spectrum insights, while the specific strain can give us a deeper understanding into specific mechanisms and benefits the probiotic can have on our complex system. For your general health, it is helpful to understand the benefit of the species without having to get into the science of the strains.

Key Features of Common Probiotic Species

Lactobacillus 

Lactobacillus acidophilus (most researched on immune)

• produces lactic acid which inhibits yeast growth
• acts as a natural antibiotics which enhances immune function
• eases symptoms of constipation and diarrhea
• helps digest and absorb nutrients and dairy

Lactobacillus casei (found in the mouth and digestive tract)

• a lactic acid bacteria
• helps break down carbohydrates
• inhibits the growth of pathogenic and putrefactive bacteria in the small intestine.
• studies suggesting : anti-microbial effects and its role in cellular immunity

Lactobacillus plantarum (major species found in the intestinal tract)

• beneficial anti-microbial activities
• produces antibodies that attack bad bacteria in the body
• supports the immune system

Lactobacillus rhamnosus (primarily found in small intestine and vaginal tract)

• one of core species for health from mouth to small intestine
• beneficial in inhibiting vaginal and urinary tract infections.
• coating mucous and preventing toxins from reaching the blood
• stimulates immune response
• studies suggesting : positive effects on weight management

 

Bifidobacterium usually stay in the large intestine

Bifidobacterium bifidum

• helps the body’s absorption of calcium, iron, magnesium and other vitamins and minerals. 
• studies suggesting: reduction in the incidence of acute diarrhea in infants, beneficial in the treatment of Inflammatory Bowel Disease, and relieves symptoms of lactose intolerance
• can improve the immunological and inflammatory response in seniors

Bifidobacterium breve

• enhances immune responses
• studies suggestion: can colonize the immature bowel of infants and is associated with better weight gain in Very Low Birth Weight infants

Bifidobacterium infantis (important for infants)

• most important microorganism found in the large intestine of infants
• effective adjunct therapy in the treatment of acute diarrhea.
• studies suggesting : efficacy on pathogens : Clostridia, Salmonella, and Shigella. B.
• stimulate the production of immuno-modulating agents

Bifidobacterium longum

• helps to synthesize B-complex vitamins
• stimulates the immune system, through its effects on immunoglobulin A (IgA).
• found to improve lactose digestion and constipation
• protects DNA from carcinogen damage

 

What affects our microbiome?

Everything! From...

• the pollution in the air
• chlorine in our water
• poor eating habits
• alcohol, sugar and a high saturated fat intake
• high sugar consumption
• over sterilization of our environment
• being in a constant state of stress
• born by C-section
• heavy metals
• bowel transit time
• allergies
• food pesticide residues, additives, preservatives, flavoring and manufacturing agents
• GI tract

The GI tract is one of the main organs that is most affected by heavy metal toxicity which is more prevalent than you think.

This goes both ways! Too acidic or too alkaline. If you’re using antacids a lot or constantly drinking alkaline water, this can also put your pH balance off. When the pH of the gut changes, the flora will also change

• Stress

Stress causes more adrenaline to be produced, and this interacts with the bowel and changes the permeability of the gut and leads to more inflammation.

Stress can be from mental, emotional stress but can also be the presence of a bad bacteria like H.Pylori or an overload of toxins in the body or even over exercising. We see that some ultra athletes end up having runner's diarrhea.

• Specific diets

For example, many people are now trying out ketogenic diet. However, circulating endotoxins are increased with the presence of more fats/oils. Probiotic helps lessen the risk of circulating endotoxin which can create inflammation.

The biggest culprit however is
antibiotics and drugs. 

Even if you avoid antibiotics when you’re sick, you have definitely been exposed to it. We are literally swimming in antibiotics. I mean, we now put antibiotics in our food for goodness sakes! Our governments allow farmers to add low doses of antibiotics to promote their growth and also keep them from being sick due to the poor conditions they are raised in.

But shouldn't we be saving these antibiotics for when we are actually sick and not dose ourselves with them when we’re eating? To me, this is insane, and also why I went vegan while I was diagnosed with cancer.

Thankfully you can now buy grassfed beef, hormone and antibiotic free chicken easier in Hong Kong, but you’re not guaranteed this while dining out. The fake meat movement is no better either. Herbicides like Roundup contain glyphosate which acts as an antibiotic. Monsanto, who has the rights to Roundup have been through court cases where they have lost and were fined for knowing that these chemicals cause cancer but they keep making and  selling them! This angers me.

Read more on how the Impossible Burger tested positive for glyphosate. 

Our microbiome is under assault. The need for change in our food system, change in our ways and a good probiotic at birth is greater than ever before. 

Our children too are being exposed to antibiotics much earlier on and are getting more vaccines than just 50 years ago. Yet we know that the first 100 days sets up a child for health. 

 

What are the symptoms of poor gut health?

Probiotics are required for all over health and the imbalance of our gut flora can lead to a host of imbalances in the rest of our body, including :

• constipation
• inflammation
• diarrhea
• bloating
• increased food allergies and intolerances
• increased sleep and mood disorders
• digestive problems like IBS, IBD, Chron’s, colitis
• nutrient deficiencies because of malabsorption (especially B Vitamins, Vitamin K, and Short Chain Fatty Acids)
• food cravings and weight gain
• memory and cognitive decline
• increased infections
• weight gain 

I always hear the complaint about how one person eats the exact same thing as their friend, but that friend never gains weight, yet they do. Sound familiar?

Well, there could be a reason behind that. And the answer could be in your gut.

There was a study published in Nature, done on mice who had antibiotics given at 10 weeks and one that didn't. The mice that had the dose of antibiotics ended up with increased body fat by nearly 10%. (see picture below) 

 

Another widely cited study  found that mice receiving an obese twins’ fecal microbiota displayed a greater fat mass than mice receiving the lean twin’s microbiota. Those bacteria inside your gut, may seem small and miniscule but their effects are mighty! 

 

 

• low immunity / autoimmunity 

Disrupting the gut microbiome can have a direct effect on the immune system. Too much unhealthy bacteria or not enough healthy bacteria opens up the gates between the cells of the gut and allows for things to enter the bloodstream that shouldn't. Your immune system recognizes it and starts producing antibodies to attack it and this is how inflammation and autoimmunity starts.

And can even lead to illnesses like :

• Chrons, IBS (irritable bowel syndrome)
• Food allergies and intolerances
• Eczema, acne (skin inflammation)
• Rheumatoid arthritis (joint inflammation)
• ADD, autism (neurological inflammation)
• Depression and Alzheimers
• Even cancer (!)

As you can see, probiotics are no longer only important for bowel health but for the promotion of health, our immune system and the prevention of disease. 

The microflora is always playing a role in our health though it may not necessarily be the cause of disease. It is the largest area of the body that is in direct contact to the exterior world. Simply because the intestinal mucosal has an enormous surface area that when expanded spans out to approximately the size of a tennis court.

It’s an enormous surface area that interacts with the external world but it’s only one cell layer thick and what feeds this cell layer is our beneficial flora. This microflora contributes to the integrity of this mucosal cell wall. When our cell wall becomes thin and we start to have ‘holes’ in our cell wall, we then have something called ‘leaky gut’.

 

Leaky Gut Explained

Our gut lining is like our inner skin. It acts as a protective barrier of foreign things from getting into our bloodstream. Just like our outer skin, we need to nourish it and give it the nutrients it needs, one of them being friendly bacteria. At the same time, we also need to protect it from outside triggers that can create inflammation and tears in the lining. These tears are like gaps in the GI tract that then allow foreign particles to seep through that shouldn’t, which then creates an inflammatory response in our system.

We eat a diet filled with chemicals that even flies and insects won’t eat and we experience chronic stress at record levels! Lessening the triggers like sugar, wheat, gluten, toxic chemicals, antibiotics or just giving your digestive system a rest from food all together can help repair our gut lining.

Other than avoiding trigger foods there are also supportive nutrients you can add to your diet to help support and strengthen your inner skin - your gut lining. 

Choline : increase choline by eating egg yolks

Vitamin A: dark leafy greens (vitamin A), green and orange vegetables

Zinc: from seeds and oysters

Fiber: try to get fiber more from vegetables rather than grains. 

 

 If you have more serious issues with your gut you may want to go slow on fiber or even come off of adding fiber in your diet all together until the gut lining is fully repaired. 

Protein: consume adequate protein. Glutamine is an amino acid that is the preferred fuel for the lining of your gut.

Healthy Fats: balance omega 3 & 6 oils. Omega 6 from damaged vegetable oils (corn, canola, soy, grapeseed, rapeseed, sunflower etc) creates inflammation. Ensure you have enough anti-inflammatory omega 3’s by consuming wildfish or flax oil.

Why do I need a probiotic?

Here are my top 4 reasons why I always recommend a probiotic supplement.

70% of our immune cells live inside our gut
We are overloaded with toxins, chemicals and pathogens
Our food system is severely void of nutrients and healthy bacteria
There are more bacteria than the number of cells in our body. We better take good care of them.

In conclusion, all people of all ages would benefit from a probiotic supplement. 
   

How to choose a probiotic supplement that is right for me?

When buying a probiotic, here are some things you should be asking.

1. Are you getting what is promised to you and printed on the label?

Some labels may claim a CFU count of 25 or even 50 billion, but is this at manufacturing or expiration?
What potency and species or strain do they guarantee?

A 2005 Consumers Choice study that looked at leading probiotic brands and found that all but one,  failed to contain the CFU (colony forming unit) count that was printed on the label. The only probiotic brand that could keep to its claim, was Udo’s Choice.

2. Stability

How stable are these strains to survive your stomach acid?
Have these species and strains been researched to reach your gut and colonize?

3. Human Adapted

 Are the strains used adapted to colonize in the gastrointestinal tract of humans?Some strains are taken from animals which won’t necessarily adapt to our human bodies. 

4. Do I need targeted strains or species?

Every bacteria does different things and with the 100 trillion bacteria living in our body, variety is key.
How many varieties of species and strains does the probiotic have?  

Probiotic Brand Comparison

In this section we’ve gathered information on a few different brands of probiotic supplements that can potentially lead you to find the best one for you.

 
Bifina S (50+10) 6 billion

Main Species & Function

1/ Bifidobacterium longum 5 billion

Bifidobacterium species are mainly found in the gastrointestinal tract and vagina and adheres to the colon. Bifidobacterium longum strains are usually found in babies and children as they pick this up through the birth canal. Therefore babies born by c-section or formula fed, typically don’t have enough of this bacteria. Bifidobacterium longum is able to survive harsh conditions like stomach acid, bile and pH fluctuations, making the species quite a stable one.

There has been some research showing specific bifidobacterium longum strains to benefit the immune system, digestion, particularly in the case of lactose intolerance and helping to metabolise fats. Bifidobacterium longum doesn’t produce spores which means it’s harder for it to replicate and travel freely around the body. 

 2/ Lactobacillus acidophilus 1 billion 

Lactobacillus acidophilus is normally found in the gastrointestinal tract and the mouth and is probably one of the most popular and researched probiotics. It grows best in low pH environments and temperatures around 37 degrees Celsius, our body’s temperature, making it easy for it to replicate and also can typically withstand stomach acid.  Lactobacillus acidophilus attaches mainly in the mucosal lining of the small intestines.

Lactobacillus acidophilus has a range of health benefits, but is most known for its ability to prevent and manage diarrhea and to restore normal bowel function. This popular probiotic species also is extremely beneficial to women as it helps protect the lining of the vagina and urethra from harmful bacteria. Therefore, women who suffer from urinary tract infections and yeast infections would greatly benefit from taking this probiotic.

As specific strains are not provided by manufacturer, functions of each species are only general and not guaranteed as functions of probiotics are strain specific. 

 

Other Ingredients: Function & Drawbacks 

• erythritol : a sugar alcohol
• edible oil: type of oil is not provided. Oil found in supplements can be oxidized 
• gelatin: likely for the capsule
• maltodextrin : likely for manufacturing of powder to increase flow
• glycerin: sweetener or excipient
• acidulant: emulsifier
• citrus pectin: flavouring
• gardenia, carotenoids: colouring which is unnecessary 
• partially hydrogenated soybean and milk constituent: additive

There are many added ingredients in this supplement that are unnecessary. The sugars and particularly the partially hydrogenated oils are of particular concern.

The 2010 Dietary Guidelines for Americans[4] specifically states: “Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.” 

 

Recommendation & Conclusion

This probiotic is not recommended. The added unnecessary ingredients do not make up for the benefits from this probiotic. There are only 2 species with unidentified strains and the CFU count is very low making it a very expensive probiotic.

 

Life Space Broad Spectrum 32 billion

Main Species & Function

1/ L. rhamnosus Lr-32 6 billion

 This lactobacillus strain has been researched and used in the treatment of diarrhea in children. The study used 20 billion CFU per dose of L. rhamnosus and L. reuteri together, twice daily for 5 days for the treatment of diarrhea.

 

2/ B. lactis BI-04 5 billion

This bifidobacterium lactis is typically found in healthy humans GI tract and is highly resistant to stomach acid. This BI-04 strain has been mainly studied to show the benefits of on immunity and allergies at dosages of 10 billion CFU. Because of its ability to stick to the intestinal wall cells for a longer period of time it will also have a longer ‘life’ in your intestines benefitting and strengthening your immune system.

3/ L. plantarum Lp-115 4.2 billion

Lactobacillus plantarum is typically found in the human  GI and mucosa and this strain is also used as a starter in many fermented foods like wine, cheese and sourdough bread. It can also survive stomach acid and has strong adhesion capabilities to the gut lining.

 This Lp-115 strain has been mainly studied to demonstrate its benefits in immune modulation in human studies particularly after antibiotics and vaccines and in animal studies have shown down regulating oxalates that are often a problem with people who have kidney stones or issues with their renal and kidney functions.

4/ L. rhamnosus GG 4 billion

Lactobacillus rhamnosus GG is one of the most used and studied probiotics and for good reason. Compared to other Lactobacillus rhamnosus’ strains the GG strain has been shown to adhere better to the mucus lining and also persists longer in the colon. This GG strains have well documented clinical benefit in the promotion of GI health in children and adults as well as allergies at doses of around 10 billion CFU. 

5/ S. thermophilus St-21 3.4 billion 

Streptococcus Thermophilus is typically found in the colon. This particular strain doesn’t have sufficient studies done on it but the species has had research showing its efficacy in improving digestion, particularly with diarrhea and IBS and enhancing immunity.

6/ L. casei Lc-11 3.2 billion

Lactobacillus Casei Lc-11 adheres well to human epithelial cells and has a few in vitro studies showing inhibition of selected pathogens such as e-coli, staphylococcus and salmonella. 

7/ L. paracasei Lpc-37 1.7 billion

Lactobacillus paracasei Lpc-37 is a common bacteria found in the human intestinal tract. The Lpc-37 strain shows good resistance to stomach acid and low pH environments but not so resistant to bile salts and pepsin. It however has shown in vitro to be beneficial in inhibiting selected pathogens particularly e-coli, staphylococcus and salmonella. 

8/ B. animalis ssp. lactis HN019 1 billion

This bifido strain has small studies showing moderate benefits on immunity in the elderly. 

9/ L. rhamnosus HN001 1 billion

This is a popular strain of probiotics researched on immunity improvement and protection and reducing anxiety and postpartum depression.  However the doses of these were larger at 10 billion CFU’s six times daily.

Other species below are too insignificant:

10/ B. breve Bb-03 800 million
11/ B. longum BI-05 500 million
12/ L. gasseri Lg-36 500 million
13/ B. infantis Bi-26 300 million
14/ L. delbrueckii ssp. bulgaricus Lb-87 200 million
15/ L. reuteri 1E1 200 million

Other Ingredients: Function & Drawbacks

Capsule ingredients and other ingredients are not disclosed on the label.

Recommendation & Conclusion

 This probiotic is good as a travelers probiotic in the case of diarrhea especially since it is shelf stable. Some of the larger CFU strains uses well researched probiotic strains. The combination of the probiotics target diarrhea symptoms more than any other symptoms. Though the variety of species and strains are wide, the CFU count of 6 of the strains are below 1 billion and may not have much of an impact on the GI tract. 

 

Culturelle Digestive Health

Main Species & Function (Only one strain/species)

Lactobacillus rhamnosus GG 10 billion

Lactobacillus rhamnosus GG is one of the most used and studied probiotics and for good reason. Compared to other Lactobacillus rhamnosus’ strains the GG strain has been shown to adhere better to the mucus lining and also persists longer in the colon.

 This GG strains have well documented clinical benefit in the promotion of GI health in children and adults as well as allergies at doses of around 10 billion CFU.

Other Ingredients: Function & Drawbacks

Culturelle includes a prebiotic in the form of inulin 200mg a natural fiber to feed the bacteria. However research on prebiotic shows that benefits of prebiotic occur at 2g. You may be better off eating more vegetables. 

Oddly they also included added sugar and fillers that are not necessary like : Mannitol and Sucrose.

 Recommendation and Conclusion

At $1.20/CFU this is an expensive probiotic. Though you are getting a strain that is well researched and a researched potency, it doesn’t justify the price. Also the added sugars will 

end up feeding the bad bacteria and yeast in our system which goes against the purpose of a probiotic. 

Udos Choice Adult Probiotic 17 billion

Main Species & Function

Lactobacillus casei HA-108: 35% 6 billion

The casei species studies show significant improvements in four main areas: immunity, allergies, cholesterol levels and digestion, particularly in chronic constipation.

Lactobacillus rhamnosus HA-111: 25% 4 billion

hown to exert antimicrobial activities against common intestinal pathogens such as E. coli, Salmonella, S. aureus and C. difficile.

Lactobacillus acidophilus HA-122: 20% 3.5 billion

This particular strain has extensive studies on  immune health, helping to reduce the risk of viral infections.

Lactobacillus plantarum HA-119: 10% 1.7 billion

This unique strain specifically targets gut permeability, maintaining the integrity of the gut to prevent or minimise bloating and gas production. This strain has been used for IBS and on eczema.  

Bifidobacterium bifidum HA-132: 5% 

Living in your stomach and intestines, this strain is found in large amounts in breastfed infants but decreases significantly as we age. As this strain has been linked to several diseases like obesity, diabetes and allergies, it is considered an important bacteria strain to boost even in our later years. 

Bifidobacterium breve HA-129: 5%

This bacteria has been shown to be particularly useful in supporting respiratory health, skin health and supporting healthy yeast levels. As one of the major strains for infants and children, it’s also been shown to help with inflammation in children.

1. Udo’s Choice Adult Probiotic

• CFU Count: 17 Billion 
• CFU Count Guarantee at Expiry: Yes
• Number of Species: 6
• Specify Strain: Yes
• Survive Stomach Acid: Yes
• Format: Capsule
• Price: $380/60 caps ; $6.33/serving

Other ingredients: potato starch, silicon dioxide (to keep dry/ prevent damage to probiotics), ascorbic acid (as an antioxidant), stearic acid.

2. Bifina S (50+10)

• CFU Count: 6 Billion 
• CFU Count Guarantee at Expiry: N/A
• Number of Species: 2
• Specify Strain: No
• Survive Stomach Acid: Yes
• Format: Powder
• Price: $299/30 packet ; $9.96/serving

Other ingredients: erythritol, edible oil, gelatin, maltodextrin, Bifidobacterium, glycerin, acidulant, emulsifier, flavor, citrus pectin, coloring (gardenia, carotenoids ), partially soy bean and milk constituent contained

 

3. Life Space (Broad Spectrum)

• CFU Count: 32 Billion 
• CFU Count Guarantee at Expiry: N/A
• Number of Species: 15
• Specify Strain: Yes
• Survive Stomach Acid: N/A
• Format: Capsule
• Price: $195/60 caps ; $3.25/serving

Other ingredients: NIL

 

4. Culturelle Digestive Health Daily

• CFU Count: 10 Billion 
• CFU Count Guarantee at Expiry: N/A
• Number of Species: 15
• Specify Strain: Yes
• Survive Stomach Acid: N/A
• Format: Tablet
• Price: $288/24 caps ; $12/serving

Other ingredients: Mannitol, Inulin, Silicon Dioxide, Sucrose (Contains Sucrose Which Adds a Dietary Insignificant Amount of Sugar. Not a Reduced Calorie Food), Maltodextrin, Sodium Ascorbate

Written by: Denise Tam, Holistic Nutritionist