With the increasing amount of evidence suggesting a connection between gut bacteria and chronic disease, it's no surprise probiotic supplements have entered mainstream consciousness in a big way.
In addition to chronic gastrointestinal conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and gastroesophageal reflux disease (GERD), imbalances in beneficial gut bacteria have also been implicated in autoimmune disorders such as Hashimoto's disease (chronic thyroditis) and rheumatoid arthritis (RA), endocrine disorders, allergies, asthma, depression and anxiety.
But with all the probiotic formulas out there, which one should you choose? We will first look at some general considerations, then compare four well known probiotic supplements.
Safety and Efficacy
Regulatory authority for dietary supplements falls under the Food and Drug Administration (FDA), and is conferred by the Dietary Supplement Health and Education Act (DSHEA) and the Nutrition Labeling and Education ACT (NLEA). These regulations give exact specifications as to the safety standards that dietary manufacturers must adhere to, as well as the types of health claims that can be made on the label.
Furthermore, probiotics produced by drug manufacturers are no more regulated than those produced by companies that don't manufacture pharmaceuticals. The regulations are exactly the same for all companies. Dietary supplements imported to the United States are also required to comply with all safety and labeling laws.
Types of Probiotic Formulations
There are three main considerations when selecting a probiotic formulation:
Organisms Per Dose -- This is typically expressed as colony-forming units (CFUs) and can vary from one to 200 billion. With rare exception, formulas delivering more 25 billion CFUs aren't available to the general public and must be obtained through a properly trained practitioner.
Mix of Probiotics -- There are around 20 different strains of bacteria, and a couple strains of yeast, that are currently in use as probiotics. Each of these has a different effect on gut ecology, which may vary from person to person. While probiotics are generally considered safe, research suggests certain genuses such as Lactobacillus may contribute to increased inflammatory molecules -- an important consideration for those with autoimmune disorders.
Delivery Mechanism -- Since probiotics are alive, they're more subject to being rendered inactive than other dietary supplements. There are many differences among formulas, with respect to how to address the issues of spoilage with exposure to heat, and for assisting the probiotics in surviving stomach acid in order to make it to the lower parts of the digestive tract where they're needed.
For those who overly bewildered by all the choices available or who suffer from chronic disease, it can be helpful to consult with a health professional with specific training in gut ecology that can make a more specific recommendation for a product and/or offer testing to more accurately determine your exact needs.