Probiotic supplements have become very popular – and with a good reason. They modulate the immune system through a variety of mechanisms and help restore balance to the gut microflora, referred to as the microbiome. But the market is flooded with choices, and choosing the best supplement is confusing. I’ve spent years researching this as both a clinician and as a patient with gastrointestinal issues, and I’ll share below what I’ve learned about probiotics.
But first, more on the microbiome.
The microbiome is a collection of trillions of organisms – bacteria, viruses, fungi and more – that live within us. A healthy microbiome helps us to stay well by improving our digestion, gut permeability, and immunity to name a few. An imbalanced microbiome, on the other hand, is linked to inflammation and chronic diseases including allergies, asthma, autoimmunity, diabetes, eczema, Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS) and obesity.
The balance of intestinal microflora is impacted by a multitude of things. Factors that can disrupt the microbiome and favor unfavorable organisms include:
Good nutrition is critical to establishing and maintaining a healthy microbiome. We now know that a shift in diet can change the gut bacteria in a matter of days. Intermittent fasting can also be of benefit. A diverse diet helps to establish desirable diversity in the microbiome, so don’t be afraid to try new things. Eat a variety of whole unprocessed foods, especially plant-based fibers. Specifically:
While diet and lifestyle habits are critical to maintaining a healthy microbiome, I continue to recommend a high-quality probiotic supplement as well. Grocery and health food stores are flooded with probiotics in the form of capsules and powders, but not all probiotics are created equal. With so many to choose from, it can be tricky and confusing.
Five things to look for when choosing a probiotic.
These are some of the brands that I routinely recommend.
Microbiome Labs MegaSporeBiotic – 2 billion spore cells/ capsule – A spore-based formula with 5 clinically researched strains of Bacillus species. After listening to a lecture from microbiologist Kiran Krishnan, one of the founders and creators of MegaSporeBiotic, I had to try it for myself. MegaSporeBiotic is now a personal favorite, and one I am using clinically for:
This product does not require refrigeration and is only available for purchase through healthcare providers. (you can contact us through the patient portal or via email at email@example.com to order for $59 with free shipping in the continental U.S.).
Xymogen ProbioMax DF – 100+ billion cfu/ capsule – Provides 4 researched strains of beneficial bacteria, including the extensively studied HN019 strain of Bifidobacterium lactis. Designed to support healthy intestinal microecology, a natural immune response, bowel regularity and lactose digestion. Comes in a foil sealed blister pack and doesn’t require refrigeration, which makes it great for travel or work. (contact us directly if you need the practitioner code to order online).
Master Supplements TruFlora – 15 billion cfu/ capsule – Contains Bacillus coagulans, Lactobacillus plantarum, Lactobacillus salivarius plus 2 digestive enzymes designed to help purge undesirable microorganisms, yeast, and waste from the digestive tract.
Metagenics UltraFlora IB – 60 billion cfu/ capsule – a 50:50 blend of Lactobacillus acidophilus and Bifidobacterium lactis Bi-07 designed to help address gastrointestinal symptoms such as abdominal discomfort, bloating, cramping, and occasional urgency.
Klaire Labs Ther-Biotic Complete – 25+ billion cfu/capsule – Contains a blend of 12 synergistic probiotic species including Lactobacillus, Bifidobacterium, and two beneficial transient lactic acid bacteria. Designed as a broad spectrum multispecies formula to restore essential intestinal microdiversity.
VSL#3 – 112.5 billion cfu/ capsule – Contains 8 strains of live freeze-dried lactic acid bacteria well supported by scientific literature. In pharmacies, VSL#3 is stored behind the counter in the pharmacist’s refrigerator, but it does not require a prescription.
Children need probiotics, too!
As a mom, probiotics are one of the main supplements I give to my own children. Some of the products listed above can be opened and used in smaller doses. My favorite child-specific brands are listed below:
MetaKids Probiotic (aka Metagenics UltraFlora Children’s Chewable) – 10 billion cfu/ chewable tablet – Made for children 3 and older with a 50:50 blend of Lactobacillus acidophilus and Bifidobacterium lactis. Formulated with xylitol, a natural sugar alcohol, that has been shown to help prevent tooth decay. This grape-flavored chewable tastes like candy, so you should have no problem with compliance!
Klaire Labs Ther-Biotic Children’s Chewable – 25+ billion cfu/ chewable tablet – Made for children 2 and older with 4 Lactobacillus and 4 Bifidobacterium species. Formulated with xylitol, a natural sugar alcohol, that has been shown to help prevent tooth decay. I like the variety and higher potency of this product, but it is not as palatable as the UltraFlora listed above. Still, my son will take it without issue (my daughter is another story).
Master Supplements Granular Theralac – 25 billion cfu per ¼ teaspoon powder – A multistrain blend with Lactobacillus and Bifidobacterium species. Designed to promote digestive health, regularity and immune health. Granules can be folded into applesauce or other soft foods. Never attempt to feed powder directly to infants or children, and remember that it can be deactivated by heat.
Klaire Ther-Biotic Infant Formula – 10+ billion cfu per ¼ tsp powder – A powdered blend of 5 Lactobacillus species and 5 Bifidobacterium species for infants and children up to 2 years old. Often helpful after cesarean section delivery, or for formula feedings, antibiotics, toxin exposures, and a maternal diet lacking in fresh fruits and vegetables. For very small infants, powder can be brushed on the nipples before breastfeeding. 1/4 tsp can eventually be mixed with expressed breast milk, formula, or solid food at room temperature. Never attempt to feed powder directly to infants or children, and remember that it can be deactivated by heat.
In search of pharmaceutical grade supplements?
You can purchase most of these for 10% off using this link to my online dispensary (free shipping over $49). If you are registered as a patient and want to try MegaSporeBiotic, contact us through the patient portal to order ($59 with free shipping in the continental U.S.). As always, talk to your health care provider before beginning a supplementation protocol or changing medications.
A few more notes…
If you’re taking probiotics on a daily basis, it’s a good idea to periodically rotate through a few different brands.
If you have severe gut dysbiosis or SIBO, you may not tolerate some probiotics well, especially if they contain prebiotic. In these cases, I generally recommend spore-form supplements like MegaSporeBiotic at a low dose that is gradually increased as tolerated.