Probiotics are living microorganisms (bacteria and yeasts) that are beneficial to the digestive system when consumed through foods or supplements. The name is quite literal, as these organisms are “pro”, in that they support and promote “biotics”, a Latin-derived word for living things. The fundamental difference separating a probiotic from harmful bacteria is their symbiotic, or mutually beneficial, relationship with your body. The human gastrointestinal tract contains trillions of gut bacteria and yeast cells, collectively known as “gut flora” or the gastrointestinal microbiome, made up of more than 500 different bacterial species. This is the largest accumulation of bacteria in any organ system. Beneficial bacteria in the digestive tract have the ability to interact and communicate with immune cells, intestinal cells and neurons in the body to influence digestive health, immune health and overall well-being. For the gastrointestinal system to function properly, gut flora must be in balance.
There are a multitude of reasons why the gut microbiome becomes unbalanced, but some of the most common are changes in diet, age, stress, travel and sleep. When beneficial bacteria are outweighed by harmful bacteria in the gut, suddenly the body becomes vulnerable to a new variety of digestive issues. The intestine is lined with adherence sites where bacteria latches on. If the sites are populated with good microbes, there is nowhere for harmful bacteria to latch on; unfortunately, the opposite is true as well. Additionally, while antibiotics are often turned to as a solution to infection in Western medicine, digestive symptoms often arise as antibiotics kill off bacteria arbitrarily, wiping out both good and bad bacteria, including both infections and beneficial gut flora. Balance can be restored, however, through the introduction of probiotics to a patient’s health regimen.
Health Benefits of Probiotics
Alleviation of uncomfortable antibiotic side-effects is only one of many benefits of adding probiotics to one’s health routine. By balancing the microflora of the gut, research has demonstrated that probiotics can improve overall digestion and encourage regular bowel movement, decrease the severity or frequency of irritable bowel syndrome, stimulate immune system response, promote healthy yeast balance and vaginal health, enhance tolerance of lactose, increase nutrient absorption from food, remedy halitosis (foul-smelling breath), and improve skin complexion. Studies have also shown that probiotics improve the bioavailability of all B vitamins as well as many essential minerals such as calcium, zinc, iron, phosphorus, copper and magnesium.
The majority of scientific evidence in probiotic research regards their role in intestinal support in various types of diarrhea. Probiotic use can slow “gut transit time” or the amount of time it takes to process and pass a meal, allowing for more absorption of nutrients and water as food slowly moves through the digestive system. On the other hand, probiotics have also been shown to increase the number of bowel movements made per week and help soften stool in patients complaining of constipation, demonstrating a role for probiotics in maintaining a healthy, regular pattern of digestion and bowel movement. Different strains of bacteria may affect the effectiveness of these supplements though, and research is continuously being conducted to specify the best strains for different intestinal conditions.
For those who suffer from travelers’ diarrhea, caused by consuming food or water contaminated with unfamiliar or harmful bacteria, Bifidobacterium bifidum and Lactobacillus acidophilus have been identified as the most helpful for gut recovery.
For bouts of infectious diarrhea, often caused by rotavirus, the probiotic bacteria strains most likely to reduce the duration and severity of diarrhea are Lactobacillus reuteri and Lactobacillus rhamnosus, although other strains may also be helpful.
Balance of microflora in the gut supports and strengthens the efficiency of the immune system. In fact, it is well documented that autoimmune disorders related to the gut (Crohn’s disease, ulcerative colitis, etc.) occur more commonly when gut microflora levels are imbalanced. There are harmful pathogens that often occupy the regions of the intestine where good bacteria should be thriving. Strong colonies of beneficial bacteria can inhibit the survival of those pathogens and also regulate the abundance of antibodies present in the intestines. One small study showed that subjects given a probiotic-containing fermented dairy drink (instead of milk) displayed increased production from lymphocytes, which are a marker of immune response. By aiding in the regulation of intestinal homeostasis and stimulating immune response, probiotics can contribute to an immune system that is well prepared to fight off disease. Lactobacillus acidophilus, Lactobacillus rhamnosus GG, Bifidobacterium animalis, and Lactobacillus paracasei are the probiotic strains that have been most extensively studied in connection to improved immune health.
Probiotics have been implicated in feminine urogenital health maintenance as well. The vagina, like the intestine, relies on a balance of certain beneficial bacteria for healthful function. Antibiotics, spermicides, and hormonal changes induced by birth control are just a few factors that can very easily throw off balance in the microflora of the vagina. Microbial imbalance can lead to bacterial vaginosis, yeast infection, or urinary tract infection. Probiotic use can aid in maintaining balance of vaginal microflora for a healthy urogenital system. Specifically, women seeking vaginal microbial balance should look for a probiotic containing Lactobacillus acidophilus, as these cultures have shown the most evidence in protecting against unwanted yeasts and bacteria in a vaginal environment. It is important to note that pregnant women are particularly susceptible to vaginal infections, and bacterial vaginosis has been indicated as a contributing factor to pre-term labor. Therefore, vaginal microbial balance and maintenance with the use of probiotics may also be a benefit to fetal health.
An inability by the body to metabolize lactose is typically due to a lack of the enzyme “lactase” and can cause serious digestive problems. Some probiotics exhibit an effect similar to lactase and are able to break down and promote the digestion of lactose. Using probiotics will not eliminate the condition of lactose intolerance but may alleviate certain irritating and painful symptoms. Bifidobacterium longum is one of several bacteria species connected to significant improvement in lactose digestion after supplementation. There are also many instances where certain yogurts have been eaten by people with a lactose intolerance, but they show no signs or symptoms. Typically, the bacterial populations of probiotic yogurts are made up of mostly Lactobacillus acidophilus and Lactobacillus bulgaricus strains. Of these, Lactobacillus bulgaricus has demonstrated the most beneficial effect on lactose intolerance.
In 2006, a study conducted at Stanford University concluded that the micro-floral populations of obese people differed significantly from the gut bacteria of normal-weighted people. It is still unclear whether or how probiotic supplements can aid in weight loss, but this Stanford finding indicates that gut flora does play a role in overall weight. Some preliminary research has shown that probiotics helped formerly obese people to maintain a healthy weight after weight loss surgery. And, in a study of post-partum women, the addition of Lactobacillus and Bifidobacterium supplementation was correlated with a smaller waist circumference. Recent research has also shown the ability of a certain strain of L. gasseri, (BNR17) to reduce visceral adipose tissue, the type of fat which is most strongly correlated with metabolic issues.
What to Consider When Choosing a Probiotic
The ISAPP (International Scientific Association of Probiotics and Prebiotics) has specified 5 criteria to consider when choosing a probiotic supplement:
- Microbe Strains: What probiotic microbes are in your supplement? The genus, species, and strain should be specified, as not all microbes act similarly, or provide the same benefits to the body. Know what species you are looking for.
- CFU (Colony Forming Units). How many live microorganisms are in each serving or dose through the expiration date (not just at the time of manufacture)? Different probiotics have been shown to be effective at various levels. The dose should match studies demonstrating their benefit(s), which typically ranges from 100 million – 10+ billion CFU/dose. Be sure to note the serving size and the frequency of dose recommended. Most probiotics should be taken daily to maximize benefits.
- Health benefits. What health benefits are claimed for this probiotic? If claims seem too good to be true, they most likely are. Be prepared to research the intended benefits of the specific strains found in your supplement and the length of time they should be taken with regularity before you are likely to notice an effect.
- Proper storage conditions. Where should the container be stored to ensure maximum survival of the probiotic? For how long will they remain stable? Generally, refrigeration in a dry environment promotes stability, but not all probiotics need to be refrigerated to remain stable.
- Corporate contact information. Be sure to purchase probiotics from a reputable manufacturer you trust, whose products are backed by science. They should be able to provide information and research supporting their product, and you should have contact information to ask questions or report any product‐related problems that arise.
What Are the Best Strains to Look for In a Probiotic?
With the wide variety of probiotic offerings available it can be hard for consumers to pick a probiotic is for their specific health needs. A recent trend in supplementation is to offer a greater diversity of strains in a supplement. This correlates with research that shows the greater the diversity of strains in a person’s microbiome associated with more robust health. Conversely, low diversity of strains in a person’s microbiome has been associated with greater risk of certain conditions from inflammatory bowel disease to cardiometabolic issues. A supplement with a diverse array of probiotics offers the potential for a wide variety of benefits. BioMaintenance® Shelf Stable Probiotic offers 12 beneficial strains for significant diversity.
It is also important to keep in mind however, that not all strains have the same therapeutic potential. Certain strains have been studied much more thoroughly regarding their health applications. In addition to health research, the safety profile of some strains is supported by a long history of use in the food industry where they have been used in making fermented foods such as yogurt. While all 12 strains in BioMaintenance® Shelf Stable Probiotic have research supporting both their efficacy and safety profile, the three highlighted below are standouts in the probiotic field.
Lactobacillus strains make up a significant portion of healthy microflora. On supplement and food labels, Lactobacillus forms are often abbreviated with an L., followed by the species name. Species in this genus all create lactic acid by metabolizing sugar. This increase in acidity creates an inhospitable environment for harmful organisms and helps to cleanse the digestive system of toxins and waste. Lactobacillus acidophilus metabolize sugar by making the enzyme lactase, which is responsible for breaking down lactose. Insufficient production of lactase by the body is the root cause of lactose intolerance. Therefore, Lactobacillus acidophilus may reduce digestion-associated discomfort in people who typically suffer from lactose intolerance.
Lactobacillus acidophilus exists naturally in the body, primarily in the intestines and the vagina. The DDS®-1 strain of Lactobacillus acidophilus contained in Metabolic Maintenance Products’ proprietary probiotic blend, BioMaintenance® Shelf Stable Probiotic, is a unique strain of L. acidophilus known to have a high tolerance to acidity, giving it strong survivability for passage through the stomach and into the bowel where it can colonize.
Lactobacillus plantarum is another species of Lactobacillus that also makes up a high proportion of BioMaintenance®. Lactobacillus plantarum has been documented to synthesize some essential nutrients, such as L-lysine. L. plantarum has significant antioxidant activities and also helps to maintain and control intestinal permeability. It has been shown to suppress the growth of gas producing bacterium in the intestines and may therefore be beneficial in the reduction of painful symptoms in patients suffering from IBS. In the gut, L. plantarum helps to create microbe balance and stabilize digestive enzyme patterns, but it has also been found to increase hippocampal, brain-derived neurotrophic factor, suggesting a beneficial role for L. plantarum in mood improvement. The ability of L. plantarum to survive in the gastrointestinal tract also makes it a great candidate for oral supplementation.
Bifidobacterium are found in the mouth, throughout the digestive tract, and make up the largest proportion of the bacterial flora in the colon. Bifidobacterium are sometimes abbreviated with a B. on ingredient or nutrition labels. Bifidobacterium species and strains play a vital role in breaking down and utilizing carbohydrates. Bifidobacterium lactis, the strain making up the highest proportion of Bifidobacterium in BioMaintenance®, is a very powerful transient probiotic bacteria. Scientific studies have show B. lactis to enhance immunity, improve digestion and aid in the healthful management of cholesterol levels more significantly than any other probiotic species yet identified.
Bifidobacterium lactis is an integral factor in supporting overall digestion of sugars, fibers, and macronutrients, and it is partially responsible for the absorption of vitamins and minerals in the gut. In the mouth, healthy B. lactis colonies can reduce the amount of cavity causing bacteria. Some studies show B. lactis can also help to reduce the frequency and severity of respiratory diseases. B. lactis also supports the integrity of the gut lining and makes it more difficult for foreign materials to pass through the gut wall into the rest of the body. It is through this effect that B. lactis has been shown to decrease toxic effects of gluten on the intestinal lining.
Should I Take Probiotics With Food?
It is possible to find a lot of conflicting information on this topic on the Internet. On one hand, probiotics were traditionally taken with food, in breast milk, our fermented foods and in soil clinging to our foods. So, it would not be unreasonable to guess they should be taken with a meal. On the other hand, certain strains of probiotics have been shown to be quite sensitive to stomach acid and digestive enzymes which are increased during digestion of a meal. There is surprisingly little specific research on the subject, but a study done in a gut model using four different strains of probiotics showed that all four strains survived better when taken 30 minutes before or with a meal. Having some fat in the meal also aided strain survival. Ingesting the probiotics 30 minutes after a meal caused a decrease in survival. But whether you choose an optimal time or not, the strains in BioMaintenance® Shelf Stable Probiotic have all been specifically chosen for strong resistance to digestion and their ability to adhere to intestinal cells in addition to their beneficial effects.
How to Help Your Microbiome Thrive!
Prebiotics are different from probiotics. Probiotics are alive and require nourishment in order to elicit an effect, so they consume substances called prebiotics as their food. Prebiotic fiber goes through the small intestine undigested and is fermented when it reaches the large intestine, feeding beneficial bacteria colonies (probiotics) and increasing the proportion of desirable bacteria in our digestive system. Research has suggested that prebiotics lead to an increase in calcium absorption and may help to improve bone density. High fiber foods such as fruits, vegetables, nuts, and legumes are typically good sources of prebiotics supplementation.
Consuming an excess of sugar, alcohol, processed food or other dietary toxins can be detrimental to the microfloral balance. Avoid taking unnecessary antibiotics when possible, as even a well-balanced microflora can be heavily disrupted by these medications.
Al-Ghazzewi, F.h., and R.f. Tester. “Impact of prebiotics and probiotics on skin health.” Beneficial Microbes (2014): 99-107.
Azcárate-Peril, M. Andrea, Michael Sikes, and José M. Bruno-Bárcena. “The Intestinal Microbiota, Gastrointestinal Environment and Colorectal Cancer: A Putative Role for Probiotics in Prevention of Colorectal Cancer?” American Journal of Physiology – Gastrointestinal and Liver Physiology 301.3 (2011): G401–G424.
Bao Y., Al K.F., Chanyi R.M., et al. “Questions and challenges associated with studying the microbiome of the urinary tract.” Ann Transl Med. (2017): 5(2):33.
Bengmark, S. “Ecological control of the gastrointestinal tract.” The role of probiotic flora Gut (1998): 42:2-7.
Bested, Alison C; Logan, Alan C; Selhub, Eva M. “Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research”. Gut Pathogens. (2013) 5 (1): 3.
Boyle, Robert J, Roy M Robins-Browne, Mimi LK Tang; Probiotic use in clinical practice: what are the risks? The American Journal of Clinical Nutrition, (June 2006): 83(6):1256–1264.
Capozzi V., Russo P., Dueñas M.T., López P., Spano G. “Lactic acid bacteria producing B-group vitamins: a great potential for functional cereals products.” Appl Microbiol Biotechnol. (2012): 96(6):1383-94.
Chilson, Morgan. 4 Best Probiotic Strains For Immune Health. Newsmax.com. (Oct. 2016).
Chouraqui et al. Acidified milk formula supplemented with Bifidobacterium lactis: impact on infant diarrhea in residential care settings. J Pediatr Gastroenterol Nutr. (March 2004): 38(3):288-92.
Corgneau M., Scher J., Ritié-pertusa L., et al. “Recent Advances on Lactose Intolerance: Tolerance Thresholds and Currently Available Solutions.” Crit Rev Food Sci Nutr. (2015).
Cunningham-Rundles, S., Ahrne´, S. and Bengmark, S. “Probiotics and immune response.” Am. J. Gastroenterol.(2000): 95:22–25.
D’Souza Aloysius L., Rajkumar Chakravarthi, Cooke Jonathan, Bulpitt Christopher J. “Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis.” BMJ (2002): 324-1361.
Hao Q., Dong B.R, Wu T. “Probiotics for preventing acute upper respiratory tract infections.” Cochrane Database of Systematic Reviews (2015): 2.
Harvard Health Publishing, Health Benefits of Taking Probiotics https://www.health.harvard.edu/vitamins-and-supplements/health-benefits-of-taking-probiotics. (Dec. 2015).
Hickson M., D’Souza A.L., Muthu N., Rogers T.R., Want S., Rajkumar C., Bulpitt C.J. “Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial.” BMJ. (Jun 29, 2007): 335(7610):80.
ISAPP Probiotics: A Consumer Guide for Making Smart Choices Developed by the International Scientific Association for Probiotics and Prebiotics. www.ISAPPScience.org. (May 3, 2016).
Janczarek M., Bachanek T., Mazur E., Chałas R. “The role of probiotics in prevention of oral diseases.” Postepy Hig Med Dosw. (2016): 70:850-7.
Kim J., Yun J.M., Kim M.Y., etal. “Lactobacillus gasseri BNR17 supplementation reduces the visceral fat accumulation and waist circumference in obese adults: a randomized, double-blind, placebo-controlled trial.” J Med Food 21 (5) 2018 1-8.
Krajmalnik-Brown, Rosa, Zehra-Esra Ilhan, Dae-Wook Kang, and John K. Dibaise. “Effects of Gut Microbes on Nutrient Absorption and Energy Regulation.” Nutrition in Clinical Practice 27.2 (2012): 201-14.
Liévin-Le Moal, Vanessa, and Alain L. Servin. “Anti-Infective Activities of Lactobacillus Strains in the Human Intestinal Microbiota: From Probiotics to Gastrointestinal Anti-Infectious Biotherapeutic Agents.” Clinical Microbiology Reviews 27.2 (2014): 167–199.
Liu, D.-M., Guo, J., Zeng, X.-A., Sun, D.-W., Brennan, C. S., Zhou, Q.-X. and Zhou, J.-S., “The probiotic role of Lactobacillus plantarum in reducing risks associated with cardiovascular disease.” Int J Food Sci Technol, (2017): 52: 127–136.
Macfarlane, G.T, Cummings, J.H. “Probiotics and prebiotics: can regulating the activities of intestinal bacteria benefit health?” BMJ. (1999): 999-1003.
Mackowiak, Philip A. “Recycling Metchnikoff: Probiotics, the Intestinal Microbiome and the Quest for Long Life.” Frontiers in Public Health 1 (2013): 52.
Melnick, Meredith. Probiotic Remedies: 6 Ways Live Active Bacteria Can Boost Your Health. The Huffington Post. (May 15, 2012).
Moayyedi P, Ford AC, Talley NJ, et al., The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut (2010): 59:325-332.
Nazario, Brunilda. Probiotics for Diarrhea. WebMD Medical Reference. (June 2018).
Niedzielin K., Kordecki H., Birkenfeld B. “A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome.” Eur J Gastroenterol Hepatol. (2001).
Papadimitriou, Konstantinos, et al. “Discovering Probiotic Microorganisms: in Vitro, in Vivo, Genetic and Omics Approaches.” Frontiers in Microbiology 6 (2015): 58.
Picard C., Fioramonti J., Francois A., Robinson T., Neant F., Matuchansky C. “Review article: bifidobacteria as probiotic agents — physiological effects and clinical benefits.” Aliment Pharmacol Ther. (2005): 495-512.
Pokusaeva, Karina, Gerald F. Fitzgerald, and Douwe van Sinderen. “Carbohydrate Metabolism in Bifidobacteria.” Genes & Nutrition 6.3 (2011): 285–306.
Reid, G. “The development of probiotics for women’s health.” Can J Microbiol. (2016).
- Biradar, S. Bahagvati, B. Shegunshi. “Probiotics And Antibiotics: A Brief Overview.” The Internet Journal of Nutrition and Wellness. (2004): 2:1.
Sanders M.E. “Considerations for use of probiotic bacteria to modulate human health.” J Nutr. (Feb. 2000):130(2S Suppl):384S-390S.
Scholz-ahrens K.E., Ade P., Marten B., et al. “Prebiotics, probiotics, and synbiotics affect mineral absorption, bone mineral content, and bone structure.” J Nutr. (2007): 137.
Sebastián domingo J.J. “Review of the role of probiotics in gastrointestinal diseases in adults.” Gastroenterol Hepatol. (2017).
Shen, N.T, Maw, A., Tmanova, L.L., et al. “Timely use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: a Systematic Review with Meta-Regression Analysis.” Gastroenterology. (2017).
Strasser B., Geiger D., Schauer M., et al. “Probiotic Supplements Beneficially Affect Tryptophan-Kynurenine Metabolism and Reduce the Incidence of Upper Respiratory Tract Infections in Trained Athletes: A Randomized, Double-Blinded, Placebo-Controlled Trial.” Nutrients. (2016): 8-11.
Stavrou G., Kotzampassi K. “Gut microbiome, surgical complications and probiotics.” Ann Gastroenterol. (2017): 45-53.
Syngai, Gareth Gordon, et al. “Probiotics – the Versatile Functional Food Ingredients.” Journal of Food Science and Technology (2016): 921–933.
Tabbers MM, Chmielewska A, Roseboom MG, et al. Effect of the consumption of a fermented dairy product containing Bifidobacterium lactis DN-173 010 on constipation in childhood: a multicentre randomised controlled trial (NTRTC: 1571). BMC Pediatrics. (2009) 9:22.
Tompkins TA, Mainville I, Arcand Y. “The impact of meals on a probiotic in transit through a model of the human upper gastrointestinal tract.” Benef Microbes. (2011) Dec1;2(4):295-303.
Unknown Author, Probiotics: In Depth. National Institutes of Health. U.S. Department of Health and Human Services (Jan.16, 2017).
Vongsa R.A., Minerath R.A., Busch M.A., Tan J., Koenig D.W. “In vitro evaluation of nutrients that selectively confer a competitive advantage to lactobacilli.” Benef Microbes. (2016): 299-304.
Waller PA, Gopal PK, Leyer GJ, et al. Dose-response effect of Bifidobacterium lactis HN019 on whole gut transit time and functional gastrointestinal symptoms in adults. Scandinavian Journal of Gastroenterology (2011): 46(9):1057-1064.
Wang Y, Ametaj BN, Ambrose DJ, Gänzle MG. Characterisation of the bacterial microbiota of the vagina of dairy cows and isolation of pediocin-producing Pediococcus acidilactici. BMC Microbiology. 2013;13:19. doi:10.1186/1471-2180-13-19.
Whorwell PJ. Do Probiotics Improve Symptoms in Patients with Irritable Bowel Syndrome? Therapeutic Advances in Gastroenterology (2009): 2(4 Suppl):37-44.
Yano, Jessica M. et al. “Indigenous Bacteria from the Gut Microbiota Regulate Host Serotonin Biosynthesis.” Cell. (2015): 264-276.
Zaharoni H., Rimon E., Vardi H., Friger M., Bolotin A., Shahar D.R. “Probiotics improve bowel movements in hospitalized elderly patients–the PROAGE study.” J Nutr Health Aging. (2011): 215-20.
Zhang Y.J., Li S., Gan R.Y., Zhou T., Xu D.P., Li H.B. “Impacts of gut bacteria on human health and diseases.” Int J Mol Sci. (2015): 493-519.
Zhong Y, Huang CY, He T, et al. Effect of probiotics and yogurt on colonic microflora in subjects with lactose intolerance. Wei Sheng Yan Jiu. 2006 Sep;35(5):587-91.