What are probiotic supplements – and are they necessary?

Nicole Dynan

18/05/2018 11:05:59 AM

There has been a lot of discussion emerging about probiotic supplements. Should GPs be advising patients to add them to their diets?

Research has shown probiotics can support digestive health and immune function, including reducing antibiotic‐associated diarrhoea, and improving resilience to infections and digestion of lactose.
Research has shown probiotics can support digestive health and immune function, including reducing antibiotic‐associated diarrhoea, and improving resilience to infections and digestion of lactose.

The short answer to the question of whether GPs should advise patients to add probiotic supplements to their diets is that practitioners need to consider each individual when deciding on supplements versus food.
If there are no published efficacy studies on a probiotic, but it seems to help, the decision about whether or not to continue it is a personal choice.
What we do know is that the potential benefits of probiotics are promising – whether from food, drink or supplement.
Probiotics are live bacteria found naturally in the gut, as well as in select foods and supplements. When taken in adequate amounts, they provide a health benefit to the person.
Here is more background on probiotics in order to help you provide an informed response to patients.
What do probiotics do?
Probiotics rarely colonise in the gut, but rather interact with resident microbes. As they pass through the gut, they interact with gut cells, immune cells and food substances, exerting their benefits.
Research has shown that probiotics can support digestive health and immune function, including reducing antibiotic‐associated diarrhoea, improving resilience to infections, and improving digestion of lactose. Other benefits include reducing the risk of eczema and colic in infants, as well as necrotising enterocolitis.
There is also some early evidence of benefits in managing weight and glycaemic control, depression and anxiety.
Are probiotics safe?
Probiotic foods and supplements have been determined to be safe for use in the general healthy population at recommended doses.
How do you choose a good probiotic product?
Not all probiotics are the same, and not all provide the same benefit to different patients. Most are from the genera Lactobacillus or Bifidobacterium or yeast.
It is best to find a product containing the strain(s) that have demonstrated the best evidence for the benefit you are seeking.
Are probiotics best acquired via food or supplement?
It is early days in terms of probiotic supplementation and, while there is some emerging evidence, more work needs to be done.
Pros and cons of probiotic supplements should be considered for each patient.

  • Some strains have a clinical impact in some disorders, such as inflammatory bowel disease (IBD) and immunity post-antibiotic treatment (eg VSL#3).
  • They are well tolerated and provide bacterial diversity, and most provide high amounts of colony forming units (CFUs) – the number of viable bacteria in sample serve.
  • Technological advances are needed before we see a boost in effectiveness.
  • High doses can result in symptoms such as gas, bloating, constipation or diarrhoea.
  • Benefits of fermented foods may go beyond the strains of bacteria (eg the bioavailability of some vitamins and minerals is elevated by the fermentation process of vegetables).
What is the effective minimum dose?
A product with a larger dose or more strains is not always better. The best dose is one that demonstrates benefits in humans, which typically ranges from 100 million to one trillion CFUs per day.
Are fermented foods a good source of probiotics?
Although fermented foods are made with live cultures, they cannot automatically be deemed a ‘probiotic’ unless the strains contained have been studied and shown to confer a health benefit.
Fermented foods high in ‘good’ bacteria include:
  • yoghurt with live cultures – look for one billion probiotics per serve 1 x 10(9) CFU
  • kefir (fermented milk or water-based drink) – usually has 30 beneficial strains of good bacteria
  • fresh kimchi (Korean fermented vegetables)
  • fresh sauerkraut (fermented cabbage).
Eating a variety of these foods can help cultivate a variety of good bacteria. Look for words such as ‘live’, ‘active’, ‘raw’ or ‘unpasteurised’ on packaging to ensure the manufacturing process has not killed the probiotic strains.
Some manufacturers of pasteurised products will add probiotic strains back into the final product. These will be listed in the ingredients. Studies have shown that the benefits of these probiotic foods are only seen while being consumed.

general-practice-nutrition nutrition probiotics probiotic-supplements

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Dr. Mark Karaczun   16/08/2019 6:44:13 AM

Good article, but a key question is if/ how probiotics survive stomach acid environment. One suggestion at the recent BritishSociety of Lifestyle Medicine (BSLM) conference in Cardiff was that taking them in a fasting state was better as simultaneous food intake will stimulate stomach acid production. It was also suggested that dehydrated/powdered supplements would be unlikely to survive as they would rehydrate in an acid environment. So, a liquid form might be better (caveat, speaker may have been sponsored by a vendor of a liquid formulation reportedly designed for cattle) suited to survive passage through the stomach. If taking a powdered supplement, the advice was to drink with copious amounts of water which seems reasonable advice. To me, eating fermented foods would allow the probiotics to hide in the matrix of the food, possibly escaping much of the stress of the low pH in the stomach.

Monet   26/09/2019 9:30:06 AM

Hi Dr Karaczun

Interesting points you have raised with different forms of probiotics and the fasting vs non fasting when taking. For me, I would always take it (capsule form) with a little bit of food just to make it easier on the stomach (sensitive gut).
I did a little research and found an interesting article discussing the clinical efficacy of probiotics supplementation - I think you'd be interested to know that they are resistance and survive against acid and bile.