How to Choose a Probiotic

10/08/2019 | 5 min. read

Dr. Drew Sinatra

Dr. Drew Sinatra

how to choose a probiotic

When you walk into a health food store or Whole Foods looking for a probiotic, it’s hard not to feel like a deer in headlights gazing at the dozens of probiotics on the shelf or in the refrigerator section. How do you know which one to pick? Which one would help you the most, and do the strains and dose really matter? 

I wish that every probiotic on the shelf was guaranteed to have high potency, research-driven strains available in each and every capsule. The unfortunate reality is that probiotics differ tremendously in how they are produced, including manufacturing practices, potency, CFU count, strains, and research claims. One may be very effective, the other a waste of money. 

Without knowing a lot about probiotics, it can be daunting trying to choose one that will work well for your body. Often people simply choose a probiotic based on how fancy or appealing the label is. Below I’ll share with you my top 7 tips for how to choose the right probiotic without solely relying on marketing appeal. 

My Top 7 Tips for How to Choose a Probiotic

1. “Live at production” versus “live at expiration.”

When a probiotic is manufactured, the CFU (colony forming units) count, also known as probiotic count or potency, is either guaranteed at the time of production or the time of expiration. I strongly suggest choosing a probiotic that guarantees the CFU count at the time of expiration, as this will give you more confidence knowing that the probiotic will still contain the CFU count listed on the label at the time of expiration. Conversely, if you buy a probiotic that is guaranteed to contain the CFU count at the time of production, the CFU count today may be 10 billion, but next year the same CFU count may be 6 billion or less, as it’s common for bacteria and yeast counts to decrease over time.

2. Variety of species.

In a nutshell, there are three basic classes of probiotics to look for on the label. You can take one class, two classes, or a combination of all three classes of probiotics. At this stage in my career, I’m typically recommending a combination product as we know from research that greater diversity in gut flora is indicative of improved health outcomes. Here are the three classes:

    1. Lactic acid-producing bacteria, such as Lactobacillus or Bifobacterium species
    2. Yeast-based probiotics, such as Saccharomyces boulardii or Saccharomyces cerevisiae
    3. Soil-based organisms or spore-forming probiotics, such as Bacillus species

There’s a common misconception that yeast in your gut is bad for you. It’s true that an overabundance of yeast can cause all sorts of problems, but we all need a healthy balance of yeast for a balanced microbiome. Just as there are harmful and beneficial bacteria, certain yeasts can be beneficial as well. 

3. CFU (colony forming unit) count.

This is really a number representing how many viable organisms (i.e., bacteria, yeast) are contained in the probiotic. There is really no right or wrong dose to take, and in fact we really don’t know what’s optimal. CFU counts are sometimes used because a research study used that particular dose. The CFU count can go upwards of 500 billion per capsule, but a higher CFU count does not necessarily mean it’s stronger or more efficacious. As a general guideline, I like to suggest a probiotic that contains at the very least 2 billion CFU’s or organisms.

4. Alphanumeric strains.

Probiotics are generally categorized into genus, species, and strain. When looking at a probiotic, ones that have letters and numbers attached to them indicate a researched strain. For example, if you look up the probiotic Bifidobacterium lactis HN019, you’ll see research showing immune enhancement properties; Bifidobacterium is the genus, lactis is the species, and HN019 is the strain. I suggest choosing a probiotic with letters and/or numbers following the probiotic strain as this tells you that particular strain was used in research.

5. Guaranteed delivery.

One option I like is the DRcapsTM (SMART capsules) delayed release delivery system. This technology protects the probiotics from the low acidity of the stomach and allows the probiotics to be more effectively delivered to the intestines where they are needed. Without special encapsulation or other delivery mechanisms, probiotics are more susceptible to damage from the low acidity of the stomach.

6. Other ingredients.

I suggest choosing a probiotic with the minimal amount of ingredients possible. In other words, look for one that does not contain unnecessary dyes/colors, preservatives, sugar, or other compounds that may not be good for your body. For example, in general I am not a fan of gummy probiotic formulas as they usually contain a lot of sugar with artificial colors, are lower quality, and stick to children’s teeth, which can predispose them to cavities. Additionally, if you are sensitive to certain foods like gluten, dairy, or soy, make sure the probiotic you choose is gluten and/or dairy and soy free. 

7. Type of packaging and storage.

You’ll want to choose a bottle that is opaque.  Clear bottles allow light in, which can damage the probiotics. Remember, probiotics are composed of live organisms, and factors such as light exposure can render them inactive over time. Also, it’s not necessary to pick a probiotic from the refrigerated section.  As long as the probiotic is shelf stable and guaranteed to contain the live organisms (probiotics) at the time of expiration, that’s actually more important than buying a refrigerated probiotic that is guaranteed to contain the probiotics at the time of manufacture. 

Summary

If you used the previous seven tips to buy a probiotic, the chances are higher that your digestive system will respond favorably. If you develop gas and bloating, know that these side effects are temporary and usually pass within a few days as your microbiome is adjusting. Within a few weeks you may notice changes in symptoms including bowel function, so keep track of how you are feeling; it’s easy to forget symptoms you had weeks or months ago. If there has been no change in symptoms including bowel habits after a couple of months, then it’s time to try another probiotic.

Even if you don’t suffer with gastrointestinal issues, I still recommend taking a probiotic for preventative reasons. Based on all the studies coming out linking gut health to mood, skin, heart, joint, and immune health, I believe that probiotics are one of the better tools we have for promoting optimal health.

Dr. Drew Sinatra

Meet Dr. Drew Sinatra

Dr. Drew Sinatra is a board-certified naturopathic doctor and self-described “health detective” with a passion for promoting natural healing, wellness, and improving quality of life by addressing the root cause of illness in patients of all ages. His vibrant practice focuses on treating the whole person (mind, body, and spirit) and finding missed connections between symptoms and health issues that are often overlooked by conventional medicine.

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