How to Pick the Best Probiotic for You

An intestinal microbe specialist explains

Trillions of bacteria live in your body, especially your large intestine. This colonic community of bacteria, known as the gut microbiota, is involved in immune health, digestion and other functions.

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Some of these microorganisms cause disease, while others fight it, and you need a proper balance of good and bad bacteria to promote good health. When this balance is thrown off, problems ensue. That’s when probiotics can be helpful.

Probiotics are beneficial bacteria similar to those normally found in your body. The myriad probiotic products on the market contain an even wider range of probiotic bacterial strains. To reap the benefits, you need to choose the right one to address your particular problem.

“If someone has disrupted his gut microbial balance, this is where a probiotic can be of benefit,” says Gail Cresci, PhD, RD, an intestinal microbe specialist with Cleveland Clinic’s Department of Gastroenterology, Hepatology and Nutrition. “But whether it’s really going to help and whether you’re taking the right one are the big questions out there.”

A probiotic primer

An imbalance in the gut microbiota is believed to contribute to a number of health problems, particularly gastrointestinal issues, as well as immune dysfunction and infections. The bacterial balance can be disrupted by medical conditions, emotional and physical stress, and, most notably, use of antibiotics, which destroy the good bacteria along with the bad.

Probiotics help tip the balance back in favor of the good bacteria. In doing so, they may provide some relief if you have irritable bowel syndrome (IBS), ulcerative colitis, acute infectious diarrhea, and diarrhea associated with antibiotic use or Clostridium difficile (C.diff) infection. They also can boost your immunity, fight inflammation and potentially have beneficial effects on cholesterol.

Choosing a probiotic

To be a true probiotic, a product must contain live and active bacterial cultures, and it should indicate as much on its packaging.

A general recommendation is to choose probiotic products with at least 1 billion colony forming units and containing the genus Lactobacillus, Bifidobacterium or Saccharomyces boulardii, some of the most researched probiotics. But you may have to delve deeper, as each genus of bacteria encompasses numerous strains that produce different results.

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For example, yogurt is made with two “starter” bacterial cultures — Streptococcus thermophilus and Lactobacillus bulgaricus — but these bacteria are often destroyed by your stomach acid and provide no beneficial effect, Dr. Cresci explains. Some companies, though, add extra bacteria into the product, so check the labeling and choose products with bacteria added to the starter cultures, she advises.

“I’d probably stay away from store brands and pay a little extra for the name brand that’s been studied,” Dr. Cresci adds. “Ideally, look for a product that’s been tested for whatever you’re looking to address. It might say it helps with IBS, but you wouldn’t take that same product if you were taking antibiotics. You would want a product that helps with immunity. That’s where a lot of people get confused.”

Some people prefer probiotic supplements over foods, but Dr. Cresci notes that probiotic foods are a better choice. In particular, fermented foods — like yogurt, kefir (a yogurt-like beverage), kombucha (fermented black tea), sauerkraut (refrigerated, not shelf-stable), kimchi (made from fermented cabbage) and tempeh and miso (made from fermented soybeans) — provide a nourishing environment in which healthful bacteria thrive and release an important byproduct: short-chain fatty acids.

“They have beneficial effects on your immunity, inflammation and cholesterol,” she says. “Go for foods first, but there’s always a niche for the supplements, like if you need a certain strain of bacteria that’s not available in a food source.”

Feed your bacteria

The probiotic industry is booming, but the benefits of probiotic products and the quantity of viable bacteria they contain can vary. So, instead of adding bacteria from an outside source, you might be better off consuming prebiotics, like fermentable fiber, which support your own beneficial bacteria, Dr. Cresci says. Good dietary sources of prebiotics include dried beans and other legumes, garlic, asparagus, onions, leeks, certain artichokes, green bananas and wheat. Prebiotic supplements are available, as well.

“What bacteria like is fermentable fiber,” Dr. Cresci explains. “I don’t know that you need a probiotic if you’re eating a healthy diet. If you want to try a one-size-fits all to improve your gut health, it’s really your diet and including prebiotics. What we eat is probably the biggest influence on our gut microbiota.”

How to get started with probiotics

Think you want to give probiotics a shot? Here are Dr. Cresci’s take-aways to help you navigate them:

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● Probiotics are generally recognized as safe, but they’re typically not recommended if you have a compromised immune system. Ask your physician if probiotics are right for you.

● It may take some trial and error to find the probiotic that works for you. If you notice no benefits from one product after a few weeks, try a different one with a different strain of bacteria.

● Probiotics may cause bloating and gas, as well as changes in your stool patterns — all indications that the product is working, Dr. Cresci says.

● Prebiotic foods help your good bacteria flourish. Include beans, asparagus, onions, green bananas and other fermentable fiber sources in your diet.

This article originally appeared in Cleveland Clinic Men’s Health Advisor.

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