8 things to know before you start taking probiotics

Today, probiotics can be found in more than just yogurt and supplement aisles. “Good bacteria” is now everywhere, from toothpaste and chocolate to juices and breakfast cereals.

“The strangest place I’ve seen probiotics is in a straw,” says Dr. Patricia Hibberd, professor of pediatrics and chief public health officer at MassGeneral Children’s Hospital in Boston, which studies the effects of probiotics on children and adults. “It’s hard to imagine how a straw can properly supply probiotics to the body,” she says.

Hibberd said she’s also not a big fan of probiotics in bread, as toasting can kill living organisms. “I’m also shocked by the cost of some of these products,” she says.

Adding probiotics to food doesn’t necessarily make it healthier or better quality, says Hibberd. “At some levels, there is more hype about probiotics than it needs to be,” she told LiveScience. “Enthusiasm is ahead of science.”

However, these facts do not dampen consumer interest: The Journal of the Business of Nutrition predicted that sales of probiotic supplements in the US in 2013 would reach $1 billion.

To distinguish between reality and hype, here are eight tips to keep in mind before you buy probiotics.

1. Probiotics are not regulated like drugs.

“I think probiotic supplements are generally safe,” says Hibberd. Even so, probiotics sold as dietary supplements do not require FDA approval to enter the market and do not pass safety and efficacy tests like medicines.

While supplement manufacturers cannot make explicit claims about the effects of supplements on disease without FDA approval, they can make general claims such as that the product “improves digestion.” There is also no standardized number of bacteria or a minimum level required.

2. Mild side effects are possible.

When people start taking probiotic supplements, they may experience gas and bloating for the first few days, says Hibberd. But even if this happens, the symptoms are usually mild, and they disappear after two to three days.

3. All probiotic foods are different.

Dairy products tend to have the most probiotics and have a good amount of live bacteria.

To get billions of beneficial bacteria in one serving, choose yogurt labeled “live and active cultures.” Other probiotic cultures include kefir, a fermented milk drink, and aged cheeses such as cheddar, gouda, parmesan, and swiss.

In addition to dairy, probiotics are found in brine-cured pickled vegetables, sauerkraut, kimchi (a spicy Korean dish), tempeh (a soy meat substitute), and miso (Japanese soy paste used as a condiment).

There are also foods that do not naturally contain probiotics, but are fortified with them: juices, breakfast cereals and bars.

Although most probiotics in food are safe for most people, it is important that the organisms in them are alive or the product will be less active.

4. Probiotics may not be safe for everyone.

Some people should avoid probiotics in food and supplements, Hibberd says. These are, for example, people with a weakened immune system, cancer patients undergoing chemotherapy. The risk is also high for people who have had organ transplants and people whose large part of the gastrointestinal tract has been removed due to illness.

People in the hospital who are on IVs should also avoid probiotics, as should people with heart valve abnormalities who need surgery because there is a small risk of infection, Hibberd says.

5. Pay attention to expiration dates.

Living organisms have a limited lifespan, so it’s a good idea to use probiotic foods before the expiration date to maximize the benefits. The storage information on the packaging must be followed to preserve the full benefit of the micro-organisms; some foods should be kept refrigerated, others at room temperature or in a dark, cool place.

6. Read labels carefully.

The amount of probiotics in a product is often unclear. The label may give information about the genus and species of bacteria, but does not indicate their number.

Supplement labels must indicate genus, species, and strain, in that order. For example, “Lactobacillus rhamnosus GG”. The number of organisms is reported in colony forming units (CFU), which represent the number of living organisms in a single dose, usually in billions.

Follow package directions for dosage, frequency of use, and storage. In his study on probiotics, Hibberd advises participants to open supplement capsules and pour the contents into milk.

7. Supplements are usually expensive.

Probiotics are one of the most expensive food supplements, often costing more than $1 a day per dose, according to ConsumerLab.com. A high price, however, is not always a sign of quality or a manufacturer’s reputation.

8. Select microorganisms according to your disease.

For people who want to prevent or cure certain diseases, Hibberd recommends finding a high-quality study published in a reputable medical journal that shows positive results. Use the foods and bacteria indicated in the study, respecting the dosage, frequency and duration of use.


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