11 Top Pharmacist Insights on Best Probiotic Supplement Per Consumer Reports

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Medically reviewed by, Russell Braun RPH

Probiotic supplements are very popular and growing in use each year. The worldwide market for probiotic sales is predicted to grow to be $7.1 billion dollars by 2026 according to a market study report. There are many reasons for this rapid growth. First of all, more and more baby boomers are suffering from digestive diseases. According to the National Institute of Digestive Diseases an estimated 70 million people are affected by digestive diseases. Likewise, the mapping of the gut microbiome is another large driver of probiotic use.

These type of stomach related issues have patients reaching for probiotic supplements to treat their ongoing symptoms.

1. What are Probiotics?

According to the International Scientific Association for Probiotics and Probiotics (ISAPP) probiotics are defined as “live microorganisms which, when administered in adequate amounts produce a health benefit on the host”

These microorganisms include many different strains of bacteria. Many foods are probiotics themselves this is especially true for “fermented foods” such as:

  • Yogurt
  • Sauerkraut
  • Pickles
  • Buttermilk
  • Some cheeses
  • Tempeh

2. Probiotics in the diet

The foods listed above act as probiotics for existing gut bacteria. Therefore, eating a diet that is rich in plant-based foods will further add to the number of different bacteria in your digestive tract. Probiotics certainly help to bolster the effect of having a good mix of bacteria present.

3. How do they work?

Millions of microorganisms such as bacteria, viruses and fungi are present in the intestinal tract. Some of these are “good” organisms because they are not harmful or even helpful to the hoast. In contrast, others are “bad” organisms that will cause harm to the host. Probiotics displace “bad” organisms from harming us by displacing them on intestinal walls. Therefore, most probiotic supplements are simply bacteria that are already found in the GI tract of humans.

Other ways probiotics work include:

  • Breaking down food causing it to be absorbed
  • Produce vitamins that the body can’t synthesize on its own
  • Help immune system to prevent attack by “bad” organisms

4. What bacteria are in probiotics?

The most common types of bacteria in probiotics are lactobacillus and bifidobacterium. Another component also frequently found in probiotic supplements is Saccharomyces a form of yeast.

Even though these are the three main major groups of microorganisms used their are literally hundereds of different species of each one. Therefore, effects can vary from one species to another.

5. Prebiotics

Preboitics are non digestible food ingredients that promote the growth of beneficial microorganisms in the intestines. The key difference between probiotics and prebiotics is that prebiotics can not be digested. As a result, prebiotics can’t be used as a source of energy from food, but rather stimulate the growth of good bacteria in the gut.

Fiber is probably the best example of a prebiotic, because it is not absorbed from the GI tract. For that reason, prebiotics feed probiotics and good bacteria along with producing bulk in the stool helping it move along and be passed in the stool.

6. Why is the microbiome important?

Prior to 2008 the bacteria found in the GI tract would have been referred to as normal flora. This simply meant bacteria that were found there naturally. More recently, the Human Microbiome Project which has been conducted by the National Institutes of Health (NIH) has focused on these microbes because their effect on the body.

The Human Microbiome is a collection of tiny organisms that live in and on the human body. There are ten times more bacteria exist on the body than there are cells that make it up. These microorganisms have genetic material that impacts how the body functions and for that reason understanding this is one of the objectives of the Human Microbiome project.

A major focus of the project is looking at how the gut microbiome directly correlates to the strength of the immune system. Healthy bacteria, such as those found in probiotics, can help bolster the immune system. Scientists believe probiotics may be able to:

  • Show the immune system how to recognize harmful bacteria.
  • Produce substances that help decrease inflammation.
  • Impact disease states by changing the bacterial makeup of the gut.

Certainly, much research is still needed to prove these theories but they do seem promising.

7. What are probiotics good for?

A quick google search will bring up hundreds of claims for probiotic supplements to cure various diseases. The table below contains some of the most common reasons people would use probiotics.

Antibiotic associated DiarrheaClostridum difficileConstipation
Diarrhea related to cancer treatmentDiverticulitisInflammatory bowel disease
Dental caariesIrritable bowel syndromeTraveler’s diarrhea
EczemaAllergic rhinitisPrevention of allergies
Hepatic diseaseRespiratory infectionUrinary tract infection
Necrotizing enterocolitisVaginal candidiasisCommon cold
Weight lossCholesterol loweringLowering blood pressure

What can you really believe?

First of all, most studies on probiotics done to date have been unblinded, not placebo controlled and look at a small number of patients. That makes it difficult to say for sure that taking probiotics for a particular problem will work. Similarly, just because one strain of probiotic was beneficial doesn’t mean that a similar strain would also be. In addition, to get the benefits shown in a particular study, you would have to be using the exact same dose of the probiotic.

Probiotics have been shown to reduce the risk of antibiotic associated diarhhea by 51% according to a meta analysis (or study of studies) about this topic. Furthermore, research is still needed to prove any of the other uses in the table above.

What is the best advice?

Talking to your doctor about the symptoms you have and if they think a probiotic would be helpful is the best first step. Likewise a pharmacist is always a good resource for questions on proboitics.

8. How to choose a probiotic?

First of all, probiotics are not considered a drug by the Food and Drug Administration (FDA). What does that mean?

It means dietary supplements are not required to follow the same regulations as prescription or over the counter drugs do. This is because dietary supplements are not allowed to make claims that they are effective at treating disease.

What is a dietary supplement?

According to the FDA, dietary supplements include such ingredients as vitamins, minerals, herbs, amino acids, and enzymes. First of all, the FDA does not have the authority or manpower to review dietary supplement products for safety and effectiveness before they are marketed. Consequently, this is the major difference in a dietary supplement and prescription or over the counter drugs! Because of this lack of testing, probiotics are NOT allowed to be marketed for treatment of any disease.

The manufacturer of the supplement is only responsible for ensuring that what is on the label is what is actually in the pill you take. Consequently, there is no a guarantee of this for the consumer in any way, shape or form.

A study from Pediatric research found that only 6% of probiotics commercially available matched the label claims from pill to pill! Rather, this means they did not have the same amount of bacteria in each pill.

Finally, many facilities where probiotics are made have been inspected and found to have violations of FDA rules affecting strength and purity.

9. Is taking a Probiotic daily safe?

Millions of people take probiotics every year and for that reason ensuring they are safe to use is very important. The vast majority are not harmed by these products. Certainly, healthy individuals have a low likelihood of experiencing any side effects from probiotics.

However, most studies of probiotics do not adequately report side effects. Most noteworthy potential side effects include:

  • Infection
  • Resistance to antibiotics
  • Problems from contaminates or other microorganisms in the product

Probiotics may not be safe for patients with weakened immune systems. Therefore, patients with the following risk factors could be at risk:

  • HIV
  • Cancer chemotherapy
  • Auto immune diseases
  • Taking immune suppressing medication
  • Premature babies
  • Elderly

How do you protect yourself and find a quality probiotic?

Thankfully, there is a process to use so you get the best product possible. Look for manufacturers that follow a process called “current Good Manufacturing Process guidelines” (cGMP). This is the FDA process for ensuring that supplement manufacturers produce their product in a clean, regulated way set out in accordance with their guidelines.

Another key component is to look for a manufacturer that adheres to the US Pharmacopeia (USP) guidelines. Above all, USP is a nonprofit organization that rigorously tests pharmaceuticals. Their goal is to ensure the following are met at the highest standards:

  • Positive identity of the product

Is the product what the manufacturer claims it is on the label?

  • Potency

Are the ingredients in the product the same strength as listed on the label?

  • Purity

Is the product free from contaminants that could be harmful?

  • Performance

Will the product break down in the body so it can be utilized?

10 Which brand of probiotics is best?

When searching for probiotics, people often rush to find answers to questions such as:

What are the 10 best probiotics?

or

What is the best probiotic supplement on the market?

The answer is…………………

It depends!

First of all, probotics should be picked based on the strains that have been shown to be beneficial for the particular problem being faced. In addition, the GI tract of each individual will vary and have different strains of bacteria.

How to shop for probiotics:

  1. ConsumerLab.com reviews dietary supplements and recommends products with at least 1 billion Colony Forming Units (CFUs). CFUs are the amount of viable bacteria in the supplement. The normal dosage range being between 1 billion to 10 billion CFUs daily for an adult.
  2. Many brands will claim they have enteric coating to help the bacteria make it through the acid produced in the stomach during digestion. There is no proof that enteric coated probiotics work better than non enteric coated. Therefore, do not pay extra for enteric coatings.
  3. Another thing to remember is different strains of bacteria can produce different effects. Also make sure that you purchase a supplement that contains strains shown to provide benefit for the reason you are taking the probiotic.
  4. Temperature flucations can cause bacteria do die or not produce desired effects, so controlling temperature is important. Consequently, some probiotics may require refrigeration. For that reason look for supplements that use freeze dried bacteria or have packaging that allows them to not require refrigeration.
  5. Finally, choosing a product that has been manufactured and held to the highest standard of pharmaceutical quality, strength, identity and purity is paramount. The only ones assured to meet these requirements are made following cGMP and meet USP standards.

11. Which brands meet these criteria?

  1. Members Mark 10 Strain Probiotic
  2. Trunature Advanced Digestive Probiotic

Members Mark features 10 strains of bacteria as the name implies. The formulation has 10 billion active cultures per capsule according to the manufacturer. The product has a delayed release because they claim this gets more bacteria past stomach acid. Finally, the product requires no refrigeration.

Strains include:

  • Lactobacillus acidophilus
  • Bifidobacterium lactose HN019
  • Lactobacillus rhamnsosus GG
  • Bifidobacterium infantis
  • Lactobacillus salivarius
  • Bididobacterium longum
  • Lactobacillus plantarum
  • Bifidobacterium bifidum
  • Lactobacillus paracasei
  • Bifidobacterium breve

Trunature Advanced Digestive Probiotic contains 12 strains of different bacteria. These capsules come in blister packaging and as a result it is easier to remember if you have taken a dose. It also helps keep the bacteria in the capsules from breaking down due to heat and light exposure.

Strains included:

  • Lactobacillus acidophilus
  • Bifidobacterium lactis
  • Lactobacillus paracasei
  • Bifidobacterium infantis
  • Lactobacillus rhamnosus
  • Bifidobacterium bifidum
  • Lactobacillus salivarius
  • Bifidobacterium longum
  • Lactobacillus casei
  • Bifidobacterium breve
  • Lactobacillus plantarum
  • Lactobacillus reuteri

How to take them

Both brands are only required to be taken once daily. Because probiotics work during digestion, the best times to take probiotics are during or immediately after a meal. Finally, both of these products are dairy free, which is great news for people with lactose intolerance.

Check back to my blog for more step by step actionable advice on high cost medications. Above all, our goal is teaching you how to use the best tools and resources available for keeping medication affordable.

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