Choosing a probiotic isn’t getting any easier.
As new offers flood the market, the different types, doses and delivery systems of probiotics offer abundant choices. But the sheer number of different probiotic supplements can be overwhelming
In a series of blogs, IPA tackled a few of the most common areas of confusion and misinformation regarding the practical aspects of probiotic use. Essentially everyone wants better answers, from healthcare workers to the consumer to the researcher testing probiotics in the lab.
As every scientist knows, microbiology doesn’t yield its secrets easily. Research science is a painstaking search for answers, which most often come slowly. The practical aspects of using probiotics have been studied but in many cases are ongoing; hopefully future studies will offer more definitive guidance.
In the meantime, here is a capsule on each of the blogs —evidence-based — in the series that may shed light on areas of concern for both consumers and healthcare practitioners. Titles are linked to the full articles on the IPA website.
- Probiotic Supplements: Single-strain or Multi-strain?
- Probiotic Supplements: What is an Adequate Dosage?
- Probiotic Supplements: Delivery Formats
- Probiotic Supplements: Does Time of Day Matter?
- Probiotic Supplements: Refrigerate or Not?
- Probiotic Supplements: Take with Antibiotics?
The current marketplace is flush with multi-strain probiotic formulations. At first glance, the rationale for these types of products is compelling: more strains may hit more targets and maybe even add up to more than the sum of the single-strain parts. But is there any evidence that this notion is valid?
Recent reviews did not find convincing evidence for the superiority of the multi-strain but several factors cloud the ability to decipher the comparisons: total dose variations, too many strains in mixtures and lack of placebo in studies.
In the past decade, probiotic supplement dosages have rocketed from millions to billions of CFUs, with some boasting as many as 200 billion.
But research shows that “adequate” dosage is variable: a lower dose may work as well or even better than a higher dose, depending on the condition or disorder for which it is being used.
Because probiotic characteristics are strain specific, the choice will depend on an individual’s purpose for taking probiotics. Most importantly, the dose should match the CFU level shown in an efficacy study to endow a benefit. Therefore, an individual’s purpose for taking probiotics will determine the dose.
Customers have a huge array of formats for their probiotic supplements including pills, capsules, powders, gummies, suppositories and liquids.
Because probiotics are live organisms, special care is mandatory. This blog describes the intricate and challenging manufacturing processes of creating each delivery format. The pros and cons of each are summarized. Each option offers specific features that may be preferable.
Whether to take a probiotic supplement with a meal or on an empty stomach — thereby pinpointing a time of day — has been a subject of debate.
IPA found a slim amount of evidence suggesting that probiotics may survive better if given before a meal. Fortunately, time may be less germane since manufacturers have developed advanced techniques to protect probiotics through the harsh environment of the stomach. Even so, check the label instructions on your product to see if there are recommendations regarding how and when to take the probiotic as formulations vary greatly.
Many people keep probiotic supplements in the refrigerator, often wedged between bottles of kombucha and cartons of yogurt. But it can get crowded. Could probiotic supplements be stored in a cupboard near vitamins and fish oil capsules?
Probiotic organisms are generally sensitive to changes in temperature and humidity. The degree that an individual product is impacted by temperature and humidity is dependent on the probiotic strains in the product, formulation matrix and dosage form, and product packaging.
New technologies and painstaking care in production, transport and storage deliver most probiotic supplements at ambient temperature. Check the label for storage instructions for the specific probiotics that meet your intended clinical need. But if you have a little extra room in your refrigerator? Go ahead and store them there. It won’t hurt and it may keep more of those beneficial microbes alive.
When antibiotics are administered, dysbiosis may occur rapidly, within days, leading to altered bacterial metabolism and impaired host proteome in mice and humans. Many studies confirm that antibiotic exposure alters the gut microbiome in children and adults. IPA describes the studies in this blog.
Antibiotics create a vacancy for opportunistic pathogens to move in or expand. Beneficial organisms are pushed out. The takeover happens fast and can last a long time.
Supplementation with probiotics to offset the effects of antibiotics has become popular. The clinical evidence supporting probiotics is reviewed.
In addition, IPA looked at studies that address whether probiotics should be taken with antibiotics or after the course as well as if probiotics are protected from antibiotics.