Ask the Doctor: Should I Take a Probiotic?

Most people know that a daily probiotic or the occasional yogurt is a good idea, but not everyone knows why or understands the options available when it comes to getting their daily dose of healthy bacteria.

In this latest "Ask the Doctor" column, Allie Nowak, a physical assistant and functional medicine specialist at Clinic Sofia OBGYN, discusses how probiotics work, dietary sources and some tips if you are considering using them.

What are probiotics?

Probiotics are the live bacteria found in food and supplements. They are similar to the bacteria found naturally in your gut and provide a wealth of beneficial effects, such as balancing and regulating the immune system, reducing inflammation, decreasing carbohydrate malabsorption, improving nutrient status, pain relief and more – all of which can have a direct influence on mood and cognition.

How do I choose a probiotic that will work for me?

• Read labels carefully. Examine the list and names of probiotic strains. If the specific names of the strains of probiotics are NOT listed on the label (it just says “live organisms”), this is a red flag for poor quality. The top probiotic strains to look for on your bottle include soil-based organisms, lactic acid bacteria (especially Saccharomyces boulardii, and possibly Lactobaccillus rhamnosus, Bifidobacterium bifidum, Bifidobacterium breve, Lactobaccilus plantarus, and Bifidobacteria infantis) and fermented foods (look for “live and active cultures” or make homemade versions). Also look for probiotic “CFU” count: Generally speaking, the higher the “colony forming units,” the better. Look for a supplement with CFUs of 50 billion or more.
• Make your own. Don’t underestimate the value and importance of probiotic foods—the concentration of organisms can be significantly higher in some fermented foods. For example, one cup of kefir contains approximately 2.35 trillion colony-forming units, or CFUs, compared to most probiotic supplements that only have a few billion. Fermented foods are much cheaper than commercial probiotics. You can make really large batches of sauerkraut only using cabbage.
• Variety is the spice of life. The best strategy is to take a wide spectrum of microorganisms, including lactic-acid producing bacteria, soil-based organisms, and beneficial strains of yeast (such as Saccharomyces). We typically recommend rotating probiotics every two to three months to keep the gut guessing.

What should I expect when taking probiotics?

As with any new change, it is wise to start slowly. When you start a new probiotic, you may initially experience a slight worsening of pre-existing symptoms, such as bloating, gas, acne, diarrhea or constipation, before you see improvement. Consider starting with one capsule every other day, then moving to one a day when you are feeling good.

What about prebiotics?

In addition to probiotics, prebiotics are essential to healing the gut, which are the starches and fiber found in foods like garlic, onions, leeks, Jerusalem artichokes, mushrooms, dates, fruits, cooked and cooled potatoes, cooked and cooled white rice, legumes and plantains that serve as FOOD for the beneficial bacteria in our gut. Put simply, probiotics are the bugs themselves and prebiotics are the food the bugs need to survive and multiply. Ultimately, you need a combination of both for a healthy gut since prebiotics help your probiotics stay around and increase beneficial bacteria.

If you are interested in talking with Allie about digestive health or other lifestyle issues, you can call Clinic Sofia at (952) 922-7600 and note that you are interested in a functional medicine consultation. You do not need to be a current Clinic Sofia patient.