Hey Everyone. Drew here, health & nutrition coach and personal trainer, answering a nutrition-related question from my friends over at Atlantic Spine Clinic in Mt Pleasant. Let’s get right into it. The Question: What is your favorite probiotic? Do you typically lean towards one specifically? A great question.
First, let’s define what we’re talking about. The World Health Organization defines Probiotics as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”  Various medical dictionaries define probiotics in various ways, as you can see from the image below…
The typical adult has around 40 TRILLION bacteria and yeast inhabiting their small and large intestines. By comparison, we have around 30 TRILLION cells in our entire body. These 40 trillion intestinal critters make up what we call the gut flora, also called the gut microbiome or gut microbiota. The average adult’s gut flora weighs about 3.5 pounds, which is actually heavier than the average adult's brain! [2-3]
The condition of the gut flora has been tied to roughly 90% of the diseases that we deal with here in the United States, so it’s an understatement to say that taking care of your GI tract and gut flora is important. 
But back to probiotics. With probiotics we have two broad options: one is to get probiotics through food, and we can also get exogenous probiotics via nutrition supplements.
There are a few food items that do contain notable amounts of probiotics per serving, including cultured veggies like kim chi & sauerkraut. Another option is the fermented tea kombucha. And still other options include yogurt and kefir, which is a drinkable type of yogurt. With these options I think cultured veggies are a great addition for most people. I think the occasional kombucha is fine, but I caution people against habitually drinking them due to the very low pH levels and the damage that can cause to the teeth. With yogurt & kefir I generally recommend high quality goat or sheep’s milk products instead of cow’s milk versions, due to the smaller molecule size and digestive issues with A1 beta casein protein, which is found in most cow’s milk products but not sheep or goat’s milk products. [5-6]
With probiotic supplements, the conversation can get complex but I’ll try to keep it as simple as I can. As far as probiotic strains go, lactobacillus and bifidobacterium strains dominate. You may also see probiotic supplements containing bacillus bacteria strains as well as saccharomyces yeast strains. Lactobacillus strains tends to be helpful for small intestinal & renal issues, whereas bifidobacterium strains tend to support the large intestine or colon, but there’s plenty of crossover here. Bacillus strains, which are sometimes called Soil Based Organisms or SBO probiotics, may be particularly helpful for those battling SIBO or Small Intestinal Bacterial Overgrowth, who otherwise have trouble tolerating more conventional probiotic formulations. And saccharomyces yeast probiotics, like those containing s. boulardii, have been clinically shown to improve intestinal barrier functioning, reduce inflammation and modulate the immune system. I do advise a little more caution with s. boulardii probiotics, as fungemia, which is an overgrowth of yeast, can occur in certain situations and at certain dosages. [7-9]
For the majority of my clients I suggest a higher dose lacto and bifido probiotic containing some of the more rigorously studied strain types. A common dosage range might be 25-100 Billion CFU, 1-3 times a day (CFU stands for colony forming units). A 2010 study from the American Journal of Gastroenterology of more than 250 adults dealing with antibiotic and c-diff associated diarrhea found that a dosage of 100 Billion CFU per day of a lactobacillus probiotic was significantly more effective than a dose of 50 Billion CFU/day. For those dealing with more acute and serious health situations, the therapeutic dosage may be even higher. For instance, at least two randomized controlled trials have used up to 3.6 TRILLION CFU per day on study participants battling mild to moderately active ulcerative colitis, with excellent results. [10-11]
So which probiotics are my favorites? As of June 2020 I’d say Healthy Origins & Renew Life are at the top of my list. For value I think Now Foods also has some decent products. All three of these companies are offering high quality, higher dose probiotics that contain a blend of clinically backed lacto and bifido strains. Again, I’d suggest picking up one containing a minimum of 25 billion CFU per capsule.
Today I’m not deep diving into what the clinical data says on which health conditions probiotics have been shown to benefit, but reviews like one from 2018 in the Journal of Clinical Pharmacology show that some of the strongest evidence is for the use of probiotics in preventing or treating conditions like colitis, diarrhea, acute respiratory infections and infant colic. Other studies have shown probiotics useful for treating constipation, IBS, obesity, immune system dysfunction and inflammation (including joint pain and arthritis). [12-14]
In talking about probiotics, gut flora & intestinal health I think its important to mention that gut health is influenced by SEVERAL factors. While probiotic supplements and foods can be a valuable tool in the fight to restore or maintain optimal gut health, don’t expect a probiotic supplement or drinking kombucha or eating yogurt to solve all of your digestive woes, especially if you have other factors that are continuing to impair optimal gut functioning.
If you want to test the condition of your gut flora, in my opinion the current gold standard test is the GI Map stool test produced by Diagnostic Solutions. This test is a little bit spendy, and often insurance doesn’t cover the cost of the test. But this is a fantastic test if you want information on which intestinal parasites, bacteria, yeasts & viruses you may be dealing with. It also has markers for occult blood, fecal fat & pancreatic enzymes. If you want a less comprehensive (and cheaper) test that focuses more on gut bacteria, gut microbiome tests like those made by Psomagen or Thryve may be good options for you. Both are available to order on Amazon.
1 www.ncbi.nlm.nih.gov/pmc/articles/PMC1479485/ (2005 article on probiotics)
3 https://books.google.com/books?id=O4KJdldvWG4C (2004 book on Probiotics)
5 www.ncbi.nlm.nih.gov/pmc/articles/PMC2516950/ (2008 study on acidic beverages & tooth erosion)
6 www.ncbi.nlm.nih.gov/pmc/articles/PMC4586534/ (2015 study on milk intolerance, including lactose & beta casein proteins)
7 https://pubmed.ncbi.nlm.nih.gov/31930437/ (2020 study on lacto & bifido strains for small intestinal conditions)
8 www.ncbi.nlm.nih.gov/pmc/articles/PMC4311309/ (2014 study on SIBO using bacillus probiotics)
9 www.ncbi.nlm.nih.gov/pmc/articles/PMC6375115/ (2019; s. boulardii has anti-inflammatory effects and preserves & restores intestinal barrier function)
10 www.ncbi.nlm.nih.gov/pubmed/20145608 (2010 study of antibiotic-associated diarrhea and c.diff-associated diarrhea showing superiority of 100B CFU vs 50B CFU)
11 www.ncbi.nlm.nih.gov/pmc/articles/PMC3424311/ (2013 article; discusses VSL #3/visbiome and using up to 3.6T CFU in clinical studies)
12 www.ncbi.nlm.nih.gov/pmc/articles/PMC6306248/ (2018; review found 68% of probiotics reviewed had strong-moderate efficacy for at least 1 type of disease)
13 www.ncbi.nlm.nih.gov/pmc/articles/PMC6213508/ (2018; 4 significant conditions have consistently been shown to respond to probiotics in humans in meta-analysis: NEC, IBS, infant colic & respiratory infections)
14 www.ncbi.nlm.nih.gov/pmc/articles/PMC6218795/ (2018; probiotics confer immunological protection to the host through the regulation, stimulation, and modulation of immune responses)