Probiotics – How to Choose the Right one?

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? 

Probiotics are defined 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 to note that if you are a generally healthy person (physically active, eat well, aren’t under a lot of stress) you likely do not need to take a probiotic. Not everyone needs a probiotic to stay healthy. Probiotics have only been identified as a treatment for specific conditions and for symptom relief. 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. 

With so many products available, and so much chatter around this “hot topic”, it’s no wonder that people are having trouble choosing the right probiotic. What often happens is that people will take something labelled “Probiotic”, or “live bacterial cultures”, but as these products often aren’t right for their diagnosis, the patient won’t see any health difference and assume that probiotics just don’t work… but how wrong they are…  

The issue of choosing the right probiotic for the right reasons has been addressed in the Clinical Guide to Probiotic Products. The Clinical Guide 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. Alliance for Education on Probiotics (AEProbio) supports publishing and distribution of this Guide.  

Within the Guide, 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 table makes it easy for you to find the product that has clinical evidence for your specific condition:  

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 guide 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.  

To quote author Dragana Skokovic-Sunjic,  “[Probiotics] might not be appropriate for all patients. They are not the solution for every single problem that ails our patients, but some of the most significant and most impactful solutions can be easily obtained by using a specific probiotic under specific conditions. As I like to say (to whoever wants to listen), “You need to use the right probiotic, for the right person, for the right reason.” 

For example, if you suffer from constipation – probiotics can help. Referring to the probiotic guide under the adult health page, under the indication for constipation – you would see that there are 6 products in the 2019 edition that have favorable published clinical evidence on relieving constipation – 5 of which have level I evidence: 

As you can see the five probiotic brands and strains have level I evidence for constipation in adults.  It also indicates the dosage form – whether it be drops, tablets, capsules, etc and the number of doses you should be taking per day.  

If you have a proper diagnosis, you can do the same for other common gastrointestinal conditions like Irritable Bowel Syndrome (IBS) and much much more!  

Be sure to check out the full guide:  www.probioticchart.ca 

For an easy video on how to navigate the website, check it out on YouTube: https://youtu.be/3B6R84pnDUw 

App Store or Google Play: PROBIOTIC GUIDE