Herding the Wild West hype of probiotic supplements (National Post - 4/27/09)

With all the hype surrounding probiotics, you might find yourself a little perplexed. While you peruse brands of yogourt that promise to do just about everything except pay your taxes, or wander through the ever-expanding section of probiotic supplements, you could be forgiven for feeling as if you haven’t got a clue where to start. Is there a brand of probiotic yogourt or a supplement that is superior to the others? And can you believe what you read on the label? These are important questions as we try to get a handle on an emerging industry. This week, the focus is on what to keep in mind when it comes to

probiotic supplements.

WHY TAKE A PROBIOTIC?

When it comes to taking any vitamin, mineral, herb or other supplement, you should always have a clear understanding of what you are taking and why. When it comes to probiotics, there is a laundry list of conditions that can be purportedly improved: lactose intolerance, diarrhea, irritable bowel syndrome (IBS), Crohn’s disease, eczema and skin conditions, yeast infections and even bad breath have all been linked to the ratio of good to bad bacteria in the digestive tract. Purveyors of probiotic supplements also boast of their ability to improve digestion and nutrient absorption, support a healthy immune system and even maintain good bone health.

At this point, research has shown quite convincingly that probiotics can help prevent or manage diarrhea, particularly when caused by antiobiotics. It also appears that, for some people, lactose intolerance can be improved through supplementation. As for everything else, there is not yet enough good research to say anything.

Based on prevailing theory and best guesses, however, it seems that a healthy digestive system does have some very real effects on the body, and our ability to digest and absorb nutrients properly undoubtedly impacts our health. So, if keeping a healthy balance of good to bad bacteria makes sense on paper, does it make sense to just pop a few pills, just to be safe?

PROBIOTIC SUPPLEMENTS: WORTH THE HYPE?

If you pick up a bottle of probiotic in supplement form, you should look for a few key pieces of information. First, take a look at the various strains of each type of bacteria. As a rule, you’ll usually find some combination of Lactobacillus and Bifidobacterium, two species of healthy bacteria commonly found in our digestive tracts. For each type of bacteria, the various strains will be listed; for example, the well-known acidophilus strain of bacteria is a part of the Lactobacillus family. Recently, more companies have started using sub-strains of each type of bacteria, leading to longer and more complicated names — and a challenge for the consumer trying to keep it straight.

To make matters worse, you may have read about a particular strain of bacteria that has shown promise in treating disease. Unfortunately, many of these strains are not commercially available, while others often have little research to support their benefit. The other key piece of information found on a supplement’s packaging is the quantity of each strain, usually expressed as live cells or colony forming units (CFUs). Most supplements claim to offer somewhere from one to 30 billion live cells per capsule, but make sure to check whether this is at the date of manufacturing or at the expiration date.

The next question concerns dosage, and the answer is we don’t really know for sure how much to take. With the usual perception that more is always better, combined with the reality that the gut plays host to a few trillion bacteria, the instinct is often to take the supplement with the highest dose, but this can lead to gas and stomach upset for new users. The best bet is to start slowly and work your way up.

WHAT ABOUT QUALITY?

Until recently, probiotic manufacturing has had a bit of a Wild West feel. Keeping probiotics self-stable required the use of expensive technology, which meant higher prices for consumers. That meant cutting corners for some manufacturers, resulting in a lower quality product. In 2006, CBC TV’s Marketplace broadcast an exposé on probiotics, and found that only one brand contained as many live cells as were listed on the product label.

According to Gary Leong, head scientist at Jamieson Laboratories, many manufacturers are cleaning up their act. Access to refrigerated storage at health food stores has improved shelf life, while the use of more advanced fermentation technology has allowed for heartier strains of bacteria. The quality of the capsules has also improved, preventing early death of the bacteria. Finally, with the publicity surrounding the possible benefits of probiotics, consumers are willing to pay for good quality, which allows manufacturers to employ the very best technology to retain shelf stability.

Mercifully, Health Canada has recently issued a series of recommendations for probiotic manufacturers, which includes a list of accepted strains, along with standards for ensuring quality of the product (note that these recommendations do not apply to food sources of probiotics) and minimum doses for each purported health benefit that can be listed on the label. These new recommendations, which go into effect immediately for all new products, are good news for consumers and manufacturers alike.

-Jennifer Sygo is a dietitian in private practice at Cleveland Clinic Canada (clevelandcliniccanada.com), which offers executive physicals, prevention and wellness counselling and personal health care management in Toronto.