girl pondering with blue microbes in the bakground

Probiotics: How to Choose the Right one

Written by: CDHF

Updated: February 8th, 2023

There’s lots of talk about probiotics these days. Probiotics in your yogurt, probiotics in your bread, even probiotics in your skincare or household cleaners! But what actually are probiotics, and why would we need them in the first place?

What are Probiotics?

If you didn’t know, The World Health Organization defines probiotics as ‘Live microorganisms which, when administered in adequate amounts confer a health benefit on the host’. In plain language, probiotics are “good bugs” or “good microbes” that are meant to help the person taking them. These friendly microbes help us digest food, maintain health, and fight disease. Many Canadians are hearing about how great probiotics are, and are looking to take them as supplements, add them to their diet or take them as needed to improve health. Seems like a pretty logical idea, right?

It’s important that you talk with your doctor, pharmacist, or dietitian first before taking a probiotic, to ensure you have a proper diagnosis, or know why you are taking it. Together, you can select an appropriate probiotic that is the most suitable for you.

How do I choose the right probiotic?

Selecting the proper probiotic for the symptoms you wish to relieve can be confusing. The Clinical Guide to Probiotic Products can help you select a probiotic that has been proven effective in reputable scientific studies. The Clinical Guide to Probiotic Products is an evidence-based decision-making tool for clinicians, which is independently prepared and updated every year. This project has been going on since 2008, and has been recognized as the only reliable resource by international healthcare associations providing health care professionals and consumers with a list of probiotic formulations that have been specifically clinically tested – so they can select the appropriate product, dose, and formulation for a specific indication. To be included in the guide, all of the inclusion criteria must be met:

1. Commercially available in Canada (or the US) as a supplement or probiotic-containing food
2. Generally Recognized as Safe status (FDA) and/or Natural Product Number (Health Canada) for probiotic strain(s) used in the products
3. Favourable published clinical evidence for the particular strain(s) present in each product
4. For products containing multiple strains, the evidence must be for the specified combination and NOT extrapolated from the evidence for the separate probiotic strains

Within the The Clinical Guide to Probiotic Products, the recommendations are tied to brand names, making it easier for you to select the recommended product when purchasing in stores. Probiotic strain names and doses are also listed. Favorable published clinical evidence for the particular strain(s) presented in each product are given and include numerous gastrointestinal conditions.

The handy acronym list makes it easy for you to find the product that has clinical evidence for your specific condition:

AAD: Antibiotic associated diarrhea (prevention)
BV: Bacterial vaginosis
C: Constipation
CDAD: Clostridium difficile associated diarrhea (prevention )
CID: Common infectious disease (community acquired)
CMPA: Cow Milk Protein Allergy
HP: Helicobacter pylori (adjunct to standard eradication therapy)
IBD-P: Inflammatory bowel disease -Pouchitis
IBD-UC: Inflammatory bowel disease – ulcerative colitis (adjunct to standard therapy)
ID: Infectious diarrhea
IBS: Irritable Bowel Syndrome
LDL-C: Reduces LDL and total cholesterol
LH: Liver Health (NASH/NAFLD/MHE; as adjunct to standard therapy; see studies for specific population)
M/A: Mood and Affect (symptoms related to stress/anxiety; not a substitute for standard treatment)
Mastitis: Mastitis in breastfeeding mothers (treatment and prevention
OH: Oral health (reductions of tonsillitis, laryngitis, and dental caries)
TD: Travellers diarrhea prevention
WM: Weight management (aids in reduction of body weight, body fat mass, and waist circumference

You will also be able to compare products based on the level of evidence, as it is graded with a I, II, or III, with level I being the highest level:

Level I:
- Evidence obtained from at least one properly designed randomize trial
Level II:
- Evidence obtained from well-designed controlled trials without randomization
- Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one centre or research group
- Evidence obtained from multiple time series with or without intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
Level III:
- Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

To make things even EASIER, the Clinical Guide to Probiotic Products also includes symbols to indicate whether or not the product is gluten free and requires refrigeration. There are also symbols `where` the probiotic product has been specifically approved by Health Canada for a specific indication. This designation is applicable only to supplements. Functional foods such as yogurts with probiotics added, and baby formulas with probiotics can not have such designations, even though they have gone through very rigorous testing.

For example, if you are an adult who suffers from irritable bowel syndrome (IBS)– probiotics can help. Referring to the probiotic guide under the adult health page (pages 7-9 of the PDF), under the indication for IBS – you would see that there are 10 products in the 2023 edition that have favourable published clinical evidence on relieving IBS symptoms – 5 of which have level I evidence. They are listed below: