Finding the Right Probiotic

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ickypoo
Regular Member


Date Joined Dec 2008
Total Posts : 224
   Posted 7/24/2009 10:40 AM (GMT -6)   
The question of probiotics (i.e. should you use them and if so which ones?) occurs regularly on this forum. The general consensus is yes, probiotics are a good idea and can contribute to better health. Yet the choice of which probiotic to take can be overwhelming given the number of brands, strains, quantities, etc. How does one determine which probiotic to buy? This has prompted me to consider if there is a good way to assess the different probiotics on the market with respect to finding the ones most beneficial to people with IBD.

The fundamental problem, as I see it, is that probiotics are not standardized. Until the day the medical profession realizes their positive therapeutic value in more than just a cursory way (which I am confident will happen sooner or later), we are left to our own devices to determine which brands work, which don't, and which may actually cause harm. Based upon my reading thus far, the following are things I think are worth considering (derived primarily from “Listen To Your Gut” by Patel-Thompson):

    1. Are strains listed? (not just species, e.g. Lactobacillus acidophilus, super strain NAS. Some strains of the same species are beneficial, some aren’t.)

    2. Do those strains have a record of promoting healthy gut flora? (May need to do some research to figure that one out.)

    3. If several strains are listed, are they isolated from one another? (Bacteria, like other living things, compete for resources. This may result in one or two strains eliminating the others. Thus you may be consuming only one or two species instead of all that are listed.)

    4. Is the quantity per serving listed? (Usually in colony forming units - cfu. An important consideration given that low doses/numbers may have no therapeutic value.)

    5. Are the strains food borne or soil microorganisms? (I personally am very hesitant to ingest soil microorganisms. It seems more reasonable to me that most of the beneficial bacteria we consume is via food. I'm also not sure if soil microorganisms would satisfy point 2 above.)

    6. Is it refrigerated? (I will not trust non-refrigerated probiotics until someone can explain to me exactly how they can remain stable for an extended period of time at or above room temperature. I have seen probiotic manufacturers claiming stability at room temperature, but I have yet to come across an explanation of how that is achieved.)

    7. Does the probiotic carry the cGMP certification (current Good Manufacturing Practices - this should help insure a quality product).


The above questions strike me as reasonable starting criteria to judge a brand given the current lack of standards. By no means to I consider this list to be the final word. If anyone wants to add or alter this list, then please do. Any other comments that can help us to identify good quality probiotics are certainly welcome. Hopefully we can sort through the good and not so good and be in a better position to decide what probiotics to buy.
Diagnosed with UC in 1990.
Current Meds: Sulfasalazine & Folic Acid.
Supplements: fish oil, flax oil, glucosamine, CoQ10, fiber, aloe vera juice, probiotics.
Other: Raw Milk for breakfast. Currently exploring a raw milk fast one day/week.


BigPanda
Regular Member


Date Joined Mar 2009
Total Posts : 54
   Posted 7/24/2009 10:49 AM (GMT -6)   
Thank you Ickypoo.

I also want to know, where do you get aloe vera juice? I want to try that.
Dx Ulcerative protitis Oct. 08 by colonoscopy
Main problem is rectum bleeding......
Canasa 1000mg / night immediately
 
Jan. 09, Asacol  3X2pill / day, off Canasa...... Began to bleed a week later
Back to Canasa 1000mg/night
 
Seems in remission now......
 
Thinking about taking some probiotic.......
 


Crybaybee
Regular Member


Date Joined Oct 2008
Total Posts : 29
   Posted 7/24/2009 11:48 AM (GMT -6)   
ickypoo said...
The question of probiotics (i.e. should you use them and if so which ones?) occurs regularly on this forum. The general consensus is yes, probiotics are a good idea and can contribute to better health. Yet the choice of which probiotic to take can be overwhelming given the number of brands, strains, quantities, etc. How does one determine which probiotic to buy? This has prompted me to consider if there is a good way to assess the different probiotics on the market with respect to finding the ones most beneficial to people with IBD.

The fundamental problem, as I see it, is that probiotics are not standardized. Until the day the medical profession realizes their positive therapeutic value in more than just a cursory way (which I am confident will happen sooner or later), we are left to our own devices to determine which brands work, which don't, and which may actually cause harm. Based upon my reading thus far, the following are things I think are worth considering (derived primarily from “Listen To Your Gut” by Patel-Thompson):

    1. Are strains listed? (not just species, e.g. Lactobacillus acidophilus, super strain NAS. Some strains of the same species are beneficial, some aren’t.)

    2. Do those strains have a record of promoting healthy gut flora? (May need to do some research to figure that one out.)

    3. If several strains are listed, are they isolated from one another? (Bacteria, like other living things, compete for resources. This may result in one or two strains eliminating the others. Thus you may be consuming only one or two species instead of all that are listed.)

    4. Is the quantity per serving listed? (Usually in colony forming units - cfu. An important consideration given that low doses/numbers may have no therapeutic value.)

    5. Are the strains food borne or soil microorganisms? (I personally am very hesitant to ingest soil microorganisms. It seems more reasonable to me that most of the beneficial bacteria we consume is via food. I'm also not sure if soil microorganisms would satisfy point 2 above.)

    6. Is it refrigerated? (I will not trust non-refrigerated probiotics until someone can explain to me exactly how they can remain stable for an extended period of time at or above room temperature. I have seen probiotic manufacturers claiming stability at room temperature, but I have yet to come across an explanation of how that is achieved.)

    7. Does the probiotic carry the cGMP certification (current Good Manufacturing Practices - this should help insure a quality product).


The above questions strike me as reasonable starting criteria to judge a brand given the current lack of standards. By no means to I consider this list to be the final word. If anyone wants to add or alter this list, then please do. Any other comments that can help us to identify good quality probiotics are certainly welcome. Hopefully we can sort through the good and not so good and be in a better position to decide what probiotics to buy.

 
I'm just going to go by the one that I buy to answer the questions.
 
  1. Yes
  2. Yes
  3. Not sure, but I doubt they would waste their time and money making something that would counteract.
  4. Yes
  5. Good question!  I have no clue
  6. Yes
  7. Yes

http://www.naturesway.com/?pid=14240

 

 


Yavw
Regular Member


Date Joined Feb 2009
Total Posts : 29
   Posted 7/24/2009 2:49 PM (GMT -6)   
I use probiotics exclusively right now, I have insurance issues right now so I don't take meds. And what I have noticed about them, is that they really do work. It is overwhelming trying to find one that works, because there are so many and they all claim to be the best one available.

I've tried a lot of different kinds. Primal defense is the only soil based probiotic I've tried. It didn't do anything for me. But all the other kinds have worked. So far I've used a generic walgreens brand, dr ohhira's, prodophilus, align, culterelle, florafiber, and dr murray's probiotics. They all have worked to varying degrees, but for me dr murray's brand has worked the best, I take 4 a day. None of them have worked 100%, but I've been able to keep a mostly normal life with them.

The walgreens brand worked pretty well, but eventually it seemed that I had to keep taking more and more to get it to work, same with culturelle. dr ohhira's didn't seem to have the cfu's to work well, I started out taking 14 a day of them, which worked, but as I reduced the amount, it wasn't as effective. And it's too expensive to take that many a day for long. Prodophilus was about the same. Align seemed to help urgency, but not flares. Florafiber bulked up my stool, but that was about it, though it increased urgency. And they seem to wear off throughout the day, whereas dr murray's has worked all the way through. I still go 5-7 times a day, but the pain/inflammation is gone, with a couple times in the day where it starts up, and then goes away.

There also seems to be a discussion about FOS, which supposedly helps the strains work better. I personally think they help, although they are long or short chain sugars, which some say makes uc worse. So maybe it works for some and not for others, dr ohhiras, prodophilus, and dr murray's all have FOS in them.

I refrigerate them, even if they say they don't need to be. I think that even the one's that claim they can be stored at room temps lose their potency over time, and refrigeration eliminates the possibility. Dr Ohhira's claimed to not need to be refrigerated because of a 3 year fermentation process it goes through, and I never refrigerated it, and it still seemed to work so maybe fermentation is what helps them survive at above chilled temps. And it said that because of that, the strains may have different amounts and kinds in it after fermentation, so that may be true about the bacteria competing with each other, I don't know to what degree it affects their quality though.

And the Dr Murray's kind has GMP certification, I never heard of that until I saw that on the bottle, and I assume that's important. So those are my thoughts on probiotics, I live by them and I'm gettin' by :) Here's the link to Dr Murray's brand from the site where I buy it from:

http://www.vitapal.com/v-natural-factors-dr-murrays-ultimate-probiotic-1212-formula-60-vegetarian-capsule_50393.aspx?utm_source=sdc&utm_medium=cpc&utm_term=natural-factors-dr-murrays-ultimate-probiotic-1212-formula-60-vegetarian-capsule&utm_campaign=sdc

ickypoo
Regular Member


Date Joined Dec 2008
Total Posts : 224
   Posted 7/25/2009 7:05 AM (GMT -6)   
So far no one has sought to alter the criteria I posted so I assume it is a good start.

Regarding the two brands mentioned (nature's way and natures secret ultimate probiotic), I could find no listing of the strains used. Perhaps I wasn't looking hard enough, but I could only find information on the species chosen, not the specific strain of each species. It bothers me when companies don't make that information readily available.

I still have difficulty believing that probiotics can maintain their potency if not refrigerated. I would think that buying those probiotics would be something of a crapshoot. Depending upon how long they have been on the shelves you could be buying a product that has many live organisms, a moderate number of organisms or nothing but bacterial corpses.

I did not come across anything from Dr. Ohira's sight on the fermentation process mentioned. How does that result in shelf stability?

Finally, for Crybaybee, you have much more confidence in the integrity of manufacturers than I do. Call me jaded, but I wouldn't put it past companies to knowingly sell a product that does not strictly adhere to what is promised, especially for products that remain largely unregulated. If the species are not isolated, I can't fathom how it is possible to insure that you are consuming what they claim you are consuming.
Diagnosed with UC in 1990.
Current Meds: Sulfasalazine & Folic Acid.
Supplements: fish oil, flax oil, glucosamine, CoQ10, fiber, aloe vera juice, probiotics.
Other: Raw Milk for breakfast. Currently exploring a raw milk fast one day/week.


ickypoo
Regular Member


Date Joined Dec 2008
Total Posts : 224
   Posted 7/25/2009 7:08 AM (GMT -6)   
BigPanda said...
I also want to know, where do you get aloe vera juice? I want to try that.


Aloe Vera juice is available in most health food stores or online. For people with IBD, it is a good idea to choose one that does not contain aloin, which can irritate your bowels. I currently use George's brand. It looks and tastes like filtered water.
Diagnosed with UC in 1990.
Current Meds: Sulfasalazine & Folic Acid.
Supplements: fish oil, flax oil, glucosamine, CoQ10, fiber, aloe vera juice, probiotics.
Other: Raw Milk for breakfast. Currently exploring a raw milk fast one day/week.


Yavw
Regular Member


Date Joined Feb 2009
Total Posts : 29
   Posted 7/26/2009 9:01 PM (GMT -6)   
ickypoo said...
I did not come across anything from Dr. Ohira's sight on the fermentation process mentioned. How does that result in shelf stability?


http://www.crohns.net/Miva/education/articles/ohhira_bacterialcount.shtml

On that site is an article about the fermentation process Dr. Ohhira's goes through. It says 5 years, but I think it's only 3 years now, it may have been 5 in 2000 when that article was written. I also don't think that lower amounts help, even when fermented, because I have better success when I took 5 at a time of them, and you're supposed to only have to take two a day, but then that may be for people without an IBD.

And I can only go off my experience with them, I never refrigerated them, and they worked pretty well, when taking high amounts. So based on that, I assume that fermentation has something to do with shelf stability.

If it wasn't so expensive, I'd still be taking it, I thought it worked well.

Post Edited (Yavw) : 7/26/2009 8:05:08 PM (GMT-6)


ickypoo
Regular Member


Date Joined Dec 2008
Total Posts : 224
   Posted 7/27/2009 10:24 AM (GMT -6)   
Yavw said...
And I can only go off my experience with them, I never refrigerated them, and they worked pretty well, when taking high amounts. So based on that, I assume that fermentation has something to do with shelf stability.


First, thanks for the link and reply. From what I gather from the article the capsules contain a lot of food in the form of FOS to keep the bugs going. They claim a shelf life of 3 years, but the article didn't provide any evidence in support. I guess you have to trust them.

Frankly, I'm not convinced that FOS is such a good idea. Other makers are quite opposed to its use (see for example the first bit on prebiotics at store.natren.com/Merchant2/merchant.mvc?Store_Code=N&Screen=CTGY&Category_Code=advice). Until I see evidence demonstrating that FOS is beneficial to the entire gut community, I will avoid probiotics that contain it (or any other non-specific prebiotic).

I also take issue with the claim that taking large numbers of bacteria is a mistake. I think it quite appropriate to start slow in order to see how your body reacts. Not everybody will be able to tolerate probiotics - especially when flaring (because of the immune response mentioned). To that extent they are correct.

But once your body is receptive to probiotics, then from what I have been able to gather, large doses may be necessary to make a therapeutic difference - which, by the way, is supported by your own experience.
Diagnosed with UC in 1990.
Current Meds: Sulfasalazine & Folic Acid.
Supplements: fish oil, flax oil, glucosamine, CoQ10, fiber, aloe vera juice, probiotics.
Other: Raw Milk for breakfast. Currently exploring a raw milk fast one day/week.


princesa
Veteran Member


Date Joined Aug 2007
Total Posts : 2204
   Posted 7/27/2009 10:42 AM (GMT -6)   
These are good guidelines. In my experience, I'd add a couple of caveats... the best performing probiotics are usually the costly ones due to specific strains and production processes. I'd also add that personal trial and error is still the gold standard. We're not all going to respond the same way to various brands. Primal Defense is a good example. Some folks report beneficial effects, some see no difference and some, like me, react adversely to it.
Diagnosed with ulcerative colitis spring 1999. Have been in remission for years with only a few minor blips. Scope on 6/22 showed no inflammation at all.
 
Maintenance dose sulfasalazine. Probiotics, vitamin D, fiber supplement and fish oil caps. George's aloe vera juice and l-glutamine for gut healing. Mostly grain-free and dairy-free low carb diet.
 
 


Yavw
Regular Member


Date Joined Feb 2009
Total Posts : 29
   Posted 7/27/2009 2:13 PM (GMT -6)   
ickypoo said...
Yavw said...
And I can only go off my experience with them, I never refrigerated them, and they worked pretty well, when taking high amounts. So based on that, I assume that fermentation has something to do with shelf stability.
Frankly, I'm not convinced that FOS is such a good idea. Other makers are quite opposed to its use (see for example the first bit on prebiotics at store.natren.com/Merchant2/merchant.mvc?Store_Code=N&Screen=CTGY&Category_Code=advice). Until I see evidence demonstrating that FOS is beneficial to the entire gut community, I will avoid probiotics that contain it (or any other non-specific prebiotic).


I get that, I'm not entirely convinced FOS is a perfect companion to probiotics either, as all the research is speculative, and results vary from person to person. That's a good article about the cons of FOS you pointed out, I can see how that could be true also. I've read before about opposition on FOS, Dr Ohhira's has done a lot of research on it, and I think he's the main reason that there are people that support FOS, because his research found that it stimulates the growth of bacteria in the colon. But it also could be that harmful bacteria thrives with it, so I guess there's no right or wrong answer as of right now whether FOS is good or not.

ickypoo
Regular Member


Date Joined Dec 2008
Total Posts : 224
   Posted 7/28/2009 6:10 AM (GMT -6)   
princesa said...
In my experience, I'd add a couple of caveats... the best performing probiotics are usually the costly ones due to specific strains and production processes. I'd also add that personal trial and error is still the gold standard.


I was hoping this would lead to the identification of a list most likely to meet the gold standard, and perhaps save some unnecessary trial and error. In addition, my concern is that people may give up too soon on using something potentially beneficial to their health if they purchase inferior products.

So...what is the list of likely suspects so far?

1. Natren
2. VSL #3?

I put a question mark on VSL #3 because I have not seen a list of strains used - just species. I'm assuming that information is available.

Since my experience with different brands of probiotics is limited I need help in adding to this list. What others satisfy the preceding criteria?
Diagnosed with UC in 1990.
Current Meds: Sulfasalazine & Folic Acid.
Supplements: fish oil, flax oil, glucosamine, CoQ10, fiber, aloe vera juice, probiotics.
Other: Raw Milk for breakfast. Currently exploring a raw milk fast one day/week.

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