What are they?

The word “probiotic” literally means promotion of microorganism growth, and they’re usually associated with health bacteria, but probiotic supplements can actually be made of bacteria, bacterial spores, or fungi (yeasts). The large majority of probiotic supplements are made from bacteria and can have a wide range of effects. Bacteria are everywhere on our body, and that’s okay! How many bacterial cells reside on and within our bodies is hotly debated, but it’s estimated to be anywhere from double to 10x the number of our own cells!(1) Bacteria are discussed as either commensal (found in the body) or non commensal (not found in the body).

The standard naming convention for bacteria and fungi is to have a genus and species listed for every type, and it’s a convention that you see with probiotic supplements as well. On the Supplement Facts panel, you’ll notice there is a capitalized first word, followed by a lower-case second word, and the words are usually in italics. Ex: Lactobacillus rhamnosus

Sometimes you’ll even see an extra few letters or numbers after the name: this clarifies the strain specificity of the probiotic. Ex: Lactobacillus rhamnosus GG

When the topic of strain specificity is discussed, it’s often the species of a bacteria/fungi that is being isolated, or even a subtype of a species. Each genus, species, and subtype can have different actions in the body.

You’ll also notice the word CFU, which stands for “Colony Forming Units”. This is a count of probiotics that the manufacturing company guarantees are in one serving of the product by the expiry date. It’s common practice for companies to include more CFU of the probiotic in the bottle at the manufacturing date to ensure that the product meets this posted amount.

Supplements-101-Probiotics Fullscript Integrative Health

How are they made?

Probiotic manufacturing is different than other supplement manufacturing processes because the category has such a large number of ingredients within it that lead to many different methods of manufacturing. One type of bacteria might be more resistant to heat, and can therefore tolerate higher temperature. Another type may not be able to withstand an acidic environment, and needs to be manufactured without any acidic ingredients in the process. Often times this means that individual strains are cultured individually and then mixed after the fact; it’s through this method that precision can be reached within the end product that reaches the market.

While each company has a slightly different process, the general process is the following (2)(3)(4):

  1. STRAIN SELECTION: Select the probiotic strain you want to culture from a bank of bacterial cells.
  2. BASE SELECTION: Choose the right base ingredient for the probiotic so it can grow (ferment) well in the optimal temperature and humidity for it to thrive. Some probiotics can have several different bases for optimal growth, so there can be multiple steps in this process. This base is often lactose or another easily fermentable carbohydrate like Fructooligosaccharides (FOS). If you’re seeking a dairy-free product, always make sure to look for that on the label.
  3. FILTRATION: Once fermented, the mixture is filtered so the bacterial strain that is being replicated is separated from the other ingredients that result from fermentation. This step often results in the majority of the water being removed from the mixture as well.
  4. DEHYDRATION: The mixture is then dehydrated some more, and often freeze dried to help prevent spoilage and to make the bacteria easier to mix and package.
  5. SEPARATION OR COMBINATION: After freeze drying, the single bacterial strains are mixed in with other probiotics for multi-strain blends, or left alone if they’re being sold as single blends.
  6. PACKAGING: Products get packaged (sometimes with additional methods to keep the bacteria alive), labelled, and sent to retailers ready to be used.

The shipping of products is an important factor of supplement efficacy that doesn’t often get discussed when talking about probiotics. Since many probiotics aren’t stable at high temperature and will diminish in CFU more rapidly at room temperature, it’s important that there is temperature control through the manufacturing, storage, shipping, and delivery of the product. Supplement companies each have particular standards about how their products are handled and these are standards we take very seriously at Fullscript!

In which forms are they available?

As was mentioned above, probiotic supplements are made of bacteria, bacterial spores, or fungi. This variety in sources means that products will have varied handling recommendations, which can sometimes be confusing for patients and practitioners alike. The most common bacterial families that are in supplements are Bifidobacterium spp. and Lactobacillus spp. (spp means “species”).

Bacillus coagulans (bacterial spore) and Saccharomyces boulardii (fungus) are two of the most common shelf stable probiotics that don’t need any additional preparation of manufacturing to make them shelf stable. They exist as spores and are stable (don’t degrade) at room temperature.

Other probiotic strains can be made shelf stable by limiting exposure to moisture, heat, and oxygen(5) by means of different packaging or manufacturing. If they don’t exist in a spore form, they’ll be diminishing in CFU over time regardless, albeit at a slower rate than without these means. Learn more by clicking here.

Much of the new research on probiotics focuses on specific families and species of bacteria as opposed to just meeting a desired CFU count. Choosing a probiotic can be difficult because of this precision in the research, which is why we made sure practitioners have the ability to find exactly what they’re looking for by using Fullscript’s advanced search tool.

There are also probiotics present in fermented food products, but there often aren’t accurately quantified amounts of the microorganisms. Since the fermentation of food typically isn’t as controlled as in the manufacture of dietary supplements, there are much higher variety of bacteria and fungi present in these fermented food products. It’s very seldom to have unposted species of probiotics in dietary supplements. However, when you’re purchasing fermented food like kombucha, sourdough bread, or sauerkraut, these fermented foods contain a wide variety of bacteria and yeasts that can impart health benefits, but are nearly impossible to specify for strain or quantity of probiotics.

How do they work?

Probiotic supplements are living things, so we want to make sure that they stay living as long as possible. Different probiotics can be taken orally, topically, or as a suppository depending on the research and purpose of the supplement. They work by helping to change the colonies that live naturally in the environments they’re exposed to. Sometimes, due to health concerns, antibiotic use, dietary patterns, lifestyle, or genetics, the normal bacteria (commensal bacteria) that live in one of these environments can diminish in numbers or get overrun by bacteria that aren’t supposed to be there (non-commensal bacteria).

Probiotic supplements help encourage the growth of commensal bacteria by directly supplementing their numbers, or by crowding out the non-commensal bacteria that have taken residence where they shouldn’t be. Probiotics also have effects on the immune system by activating cytokines (chemical messengers) that help the body fend off viruses, and non-commensal bacteria that can cause illness and disease. On the other hand, by influencing the population of commensal bacteria, probiotics can also have an anti-inflammatory effect by downregulating the immune system. Probiotics help the body better distinguish between self and non-self as well, an important part of helping patients with autoimmune conditions.

Most probiotics are bacteria and require refrigeration because they lose potency and numbers at warmer temperatures. Sometimes companies will add additional ingredients to probiotic products to extend their shelf life, but for the most part, probiotics should be kept in the fridge. Unless specifically stated, probiotics keep much longer in the fridge, whereas their shelf life is much shorter when not refrigerated. However, some types of probiotics are bacteria that live as spores, which means they’re in inactive states that are very resilient to fluctuations in temperature. These typically don’t need refrigeration and won’t lose CFU count or potency as time goes on.

Probiotics can also be fungi, like brewer’s yeast, which don’t require refrigeration. Refrigeration can prolong the life of these probiotics, but typical dosing should mean that the bottle runs out before the product goes bad on the shelf.

How can probiotics help?

Probiotics are well known for their beneficial effects on the gastrointestinal system, in particular helping with the cramping, bloating, and discomfort associated with irritable bowel syndrome (IBS); but this is just the tip of the iceberg. Not only are probiotics helpful for patients with IBS, but they’re also used in irritable bowel disease (IBD) and Clostridium difficile associated diarrhea to reduce the need for medications, and decrease the length of hospital stays.(6)

As our understanding of the immune system deepens, it has become more and more clear that probiotics have a role to play here as well. Over two thirds of a human’s immune system lives in the gut, and the interaction between the bacteria in our intestines and the rest of our immune system is a pivotal relationship. Probiotics have an impact on the types and numbers of bacteria that live in our guts, and research continues to be released on the effects of probiotics on a broad range of immune mediated conditions; both from external pathogenic bacteria and autoimmune conditions.(7)

Recent research has also clarified a link between the GI system and mental health status. Probiotics have repeatedly shown benefits for patients with depression in various studies. However, there remains some inconsistency in the kinds of strains, amount of CFU, and duration of treatment that lead a recent systematic review to recommend more research be performed before using probiotics in place of other effective therapies for depression.(8)

probiotic supplements gut health

Are there side effects?

Paradoxically, probiotics can sometimes cause the very symptoms they are intended to treat when it comes to gastrointestinal concerns. While most patients with IBS or IBD can benefit from probiotics and get some symptom improvement, there are some patients whose symptoms can worsen when taking probiotic supplements. This can happen for a few reasons:

Yeast vs Bacteria

  • Some patients can react to yeast more than bacteria because they can grow in different conditions. Certain strains of bacteria (or even subtypes) can cause varying side effects as well.

Combination products with other medicinal ingredients or non-medicinal ingredients

  • Prebiotics (digestible fibres) are often added into probiotic formulas to help the bacteria survive longer in the capsule and to grow better once they reach your small intestine. Unfortunately, some patients can experience gas, bloating, and cramping from the prebiotics that get added. Look for “FOS free” probiotics if prebiotics cause any digestive problems; they won’t have any added fibers in the products.

Manufacturing Process

  • Patients with dairy anaphylaxis should be careful to select dairy-free probiotics only, since many of the probiotics on the market are grown with lactose (the main carbohydrate in dairy milk) as part of the manufacturing process.

We strongly recommend that you speak with a healthcare professional before starting any dietary supplement, and if you’re currently taking a probiotic supplement, always tell your healthcare practitioner about it. With complete information about the supplements you’re taking, your practitioner will be better able to make a plan to help you reach your health goals.

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Ther-Biotic Children's Chewable Klaire Labs

Ther-Biotic Children’s Chewable by Klaire Labs

Ther-Biotic® Children’s Chewable is a broad-spectrum, hypoallergenic probiotic supplement designed for children 2 years of age and older. Our 25 billion CFU formulation, in a base of inulin, contains eight total Lactobacillus and Bifidobacterium species which have been intensively researched and clinically shown to support gastrointestinal health and immune function in children.

Ortho Biotic by Ortho Molecular Products

Ortho Biotic by Ortho Molecular Products

Ortho Biotic is a unique probiotic formula designed to deliver active organisms shown to promote healthy gut microflora, protect intestinal integrity and boost immune function. Included in this formula is Saccharomyces boulardii, an extensively researched microorganism shown to help restore microflora balance by enhancing commensal organism function. Each Ortho Biotic capsule provides seven proven probiotic strains chosen for their ability to withstand the harsh gastrointestinal (GI) environment and adhere to the intestinal tract to deliver superior results.

Ther-Biotic Complete by Klaire Labs

Scientifically formulated with a full spectrum of synergistic and complementary species, Ther-Biotic® Complete is designed for individuals who require significantly higher amounts of several different types of probiotic species to help support intestinal health. Formulated with 25+ billion CFUs per capsule, Ther-Biotic® Complete uses our proprietary InTactic® technology to ensure maximum delivery of live microorganisms throughout the intestinal tract.

  1. Abbott, Alison. “Scientists Bust Myth That Our Bodies Have More Bacteria than Human Cells.” Nature, Jan. 2016, doi:10.1038/nature.2016.19136.
  2. http://www.lallemand-health-solutions.com/en/manufacturing/
  3. Gueimonde, Miguel, and Borja Sánchez. “Enhancing Probiotic Stability in Industrial Processes.” Microbial Ecology in Health and Disease, vol. 23, June 2012, doi:10.3402/mehd.v23i0.18562.
  4. “Production Process.” Winclove Probiotics, 30 Sept. 2016, https://www.wincloveprobiotics.com/product-quality/production-process.
  5. Shah, N. P. “Probiotic Bacteria: Selective Enumeration and Survival in Dairy Foods.” Journal of Dairy Science, vol. 83, no. 4, Apr. 2000, pp. 894–907.
  6. Goldenberg, Joshua Z., et al. “Probiotics for the Prevention of Clostridium Difficile-Associated Diarrhea in Adults and Children.” Cochrane Database of Systematic Reviews , vol. 12, Dec. 2017, p. CD006095.
  7. Yan, Fang, and D. B. Polk. “Probiotics and Immune Health.” Current Opinion in Gastroenterology, vol. 27, no. 6, Oct. 2011, pp. 496–501.
  8. Wallace, Caroline J. K., and Roumen Milev. “The Effects of Probiotics on Depressive Symptoms in Humans: A Systematic Review.” Annals of General Psychiatry, vol. 16, Feb. 2017, p. 14.