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Probiotics are beneficial bacteria that reside in our small and large intestines that support healthy digestive function, regulate our immune systems, produce enzymes that can kill pathogenic bacteria, and provide nutritional support, including production of vitamin K.  Probiotics have been shown to reduce IBS, allergy, and cancer risk.  Levels of these good bacteria can decrease due to many factors, including:

  • Age
  • Antibiotic and other medication use
  • Infection
  • Lifestyle
  • Poor diet, especially low fiber
  • Stress
  • Digestive disorders
  • Travel


Probiotics may be found in yogurt and fermented foods, but the highest amounts of beneficial, live cultures are found in high quality supplements.  Sources of probiotic supplements include human, animal, vegetable, and soil.


When choosing a probiotic supplement, there are several factors to consider:

  • Are the strains proven to be totally non-pathogenic?
  • Are the strains indigenous and appropriate for humans?
  • Are the strains proven to be capable of colonization?
    • Can the strains resist stomach acid and bile salts, both of which are antimicrobial?
    • Can the strains actually attach to the cells lining the intestine?
    • Have the stains been shown to regulate the immune system in humans?
  • Is there scientific evidence to support their use, i.e., published data from independent, clinical trials in humans?
  • Does the manufacturing company have a quality assurance program that provides its testing information to practitioners?


There are also many strains of bacteria that are included in many probiotics.  The biggest question regarding those strains is: do they work?  One well-characterized strain known to work is going to be more effective for a patient than ten strains that don’t work or have no supporting evidence.  For example, if a product contains 100 billion organisms, but none of them adhere to the intestines, then they will all be flushed out and have no or minimal health effects.  Additionally, many enteric coatings don’t dissolve until the end of the small intestine, so the beginning and middle portions of the small intestine (the main areas of colonization) are missed.


I use Genestra and Pharmax brands because they meet all these criteria and are the only brands approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) inEuropeto be used in scientific, clinical trials.  These brands also have a 50 percent overage in the number of live organisms at the time of manufacture.  This is done to ensure that the label claim of number of live organisms is still met if the product is kept at room temperature for 24 months.  For example, the label of HMF Forte says there are 10 billion live organisms per capsule.  At the time of manufacture, each capsule has 15 billion and refrigeration will maintain that overage.  Many of their products also contain fructo-oligosaccharides (FOS), which is a form of soluble fiber that serves as food for the probiotics.  Several products also contain glutamine for repairing small intestine permeability and supporting nervous system function.


Some guidelines for taking probiotics:

  • Always take probiotic with food to reduce the effects of stomach acid.
  • Maintenance of normal flora levels requires supplementation of 2 to 10 billion organisms/day.
  • Therapeutic effects in the small intestine (e.g., preventing infection, immune system regulation) require doses of ≥25 billion organisms/day.
  • Therapeutic effects in the large intestine (e.g., effects of broad-spectrum antibiotics, inflammatory bowel disease) require doses of ≥ 100 billion organisms/day.
  • Children over 5 years old can receive adult doses.  Children under 5 years old should receive a probiotic specifically designed for young children, as the total amounts and overall balance of organisms will be different than products for adults.
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