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Choosing the Right Probiotic

What to Look for in a Probiotic
Submitted by Integrative Therapeutics, Inc.

Probiotics can be consumed in supplemental form and by eating fermented foods, which naturally contain live cultures. Some research has shown that probiotics must contain a minimum of 10 million colony forming units (CFU) per gram at the time of consumption to provide the associated health benefits. Since probiotics are complex microorganisms that are sensitive to heat, light, moisture, and acidic environments, proper processing and storage of the probiotics are essential to ensure their survival.

To experience health benefits from probiotic supplementation, it's important to understand what attributes make a probiotic effective. Before determining which probiotics to use, their source, the amount of good bacteria they contain, and if the product has gone through the process of expiration dating, are important to determine the intention of using such an intervention.

The quantity and strains of a probiotic doesn't matter if they are not stable. A good manufacturer will have testing on file and can verify that the product has met all requirements to ensure the product remains stable throughout its shelf life—when stored according to the directions. Look for a supplement that lists an expiration date. Expiration dating is not a label requirement for supplements, so a manufacturer who provides one are making the claim that the CFU count provided at the time of manufacturing, holds true to the expiration date.

Gas and light permeability through the packaging can influence the survival of probiotics. Probiotic supplements are typically packaged in opaque material to protect the probiotics from light and oxygen. Also, certain plastics can be better for probiotics. Some probiotics are packaged in a box, rather than a bottle and may even have an oxygenbarrier blister pack where each capsule is individually protected. You should note the storage requirements as well. Almost all probiotics used to require refrigeration; however, new processing techniques have allowed some probiotics to be stored at room temperature. Once consumed, survival includes the ability for the strains to reach their destination in the intestines, all while surviving harsh stomach acids.

Probiotics are popular thanks to a rich research environment of microbiota, microbiome, and emerging human clinical data. Despite the knowledge that has been accumulated, a lot of unanswered questions remain in regards to genus, species, and strain. One method that integrative medicine practitioners use to choose probiotics is matching a patient's status with those of subjects of clinical research. These products may contain a single species (precision probiotics) or they could contain a broad spectrum (a combination of genera in its most diverse form or different strains of the same species in one formula).

CFU Count
But wait, that's not all. The relevant number of colony forming units has yet to be addressed. While 10 million CFUs was referenced earlier, probiotics can range up to 900 billion CFUs—with most products in the 1 to 50 billion range. How many CFUs are necessary to achieve the intended health benefits? That's largely unanswered, but information continues to be published in this regard.

Dose, type, delivery, preparation, packaging, and storage are all decision factors in regards to probiotics. That means, the innocent question of "what's the best probiotic?" quickly becomes complex. But, if you make sure the probiotics you choose incorporate all the factors discussed, it can ensure you are getting the best quality probiotic, which will help maximize their beneficial effects.

Lauren M. Martin, MS, CNS
Lauren Martin is a Certified Nutrition Specialist who earned a Master of Science in Human Nutrition from Columbia University.

Corey Schuler, RN, CNS, LN, DC
Corey Schuler is the Director of Clinical Affairs for Integrative Therapeutics.

*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease

Probiotic Considerations for Women
Submitted by Integrative Therapeutics, Inc.

When researching a probiotic that is ideal for a man or woman, you must take into account the outcome you wish to achieve, the effectiveness of the probiotic, and how it can improve your digestive function. Long term changes to digestive secretions, from medications, stress, or a variety of other environmental and outside circumstances, may eventually be a factor in the type and quantity of microbes residing in the digestive tract.

When considering probiotics for men and women, the ability to survive gastric secretions is key to their beneficial action. Lactic acid bacteria, such as Lactobacillus and Bifidobacterium have an increased ability to survive this type of environment. Since probiotics are complex microorganisms that are sensitive to heat, light, moisture, and acidic environments, proper processing and storage of the probiotics are vital to ensure their survival. Once the probiotics arrive in the appropriate part of the digestive tract, it is important to create an environment in which they can thrive.

Probiotics for women are often recommended to promote an appropriate balance of microflora to prevent yeast overgrowth, but they can have other benefits as well. Lactobacilli are found in the digestive and urogenital tracts; however, there are differences in the species based on location. The most dominant species found in the vagina are L. iners, L. crispatus, L. acidophilus, L. rhamnosus, and L. reuteri. Hormonal changes, such as menopause or the menstrual cycle, can affect these microbial populations.

Gut bacteria are also suspected to play a role in the metabolism of estrogen. In healthy, post-menopausal women, a small study demonstrated that increased microbial diversity was associated with a high ratio of metabolites to parent estrogen. In another study with healthy participants, post-menopausal women and men had similar urinary estrogen metabolites, which were directly associated with fecal microbiome richness and diversity.

When considering what probiotic is best for a woman, dose, type, delivery, preparation, packaging, and storage are all important factors. However, you also need to consider your presenting health concern as well as the reproductive stage of life you are currently experiencing.

Anne Thiel, ND
Anne Thiel is a licensed naturopathic physician who completed a hospital-based residency in naturopathic oncology at Goshen Center for Cancer Care.

1. Khoder G, Al-Menhali AA, Al-Yassir F, Karam SM. 2016; 12(1):3-17.
2. Sah BNP, Vasiljevic T, McKechnie S, Donkor ON. 2015; 98(9):5905-16.
3. Ying D, Sanguansri L, Weerakkody R, et al. 2016; 25:447-58.
4. Waigankar SS, Patel V. Journal of Mid-Life Health. 2011; 2(1):5-10.
5. Fuhrman BJ, Feigelson HS, Flores R, et al. The Journal of Clinical Endocrinology and Metabolism. 2014; 99(12):4632-40.
6. Flores R, Shi J, Fuhrman B, et al. Journal of Translational Medicine. 2012; 10:253.

*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease

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