What about probiotic supplements?
While it's important to have a food-first approach, supplements can help. The only drawback? Well, probiotics are sold as dietary supplements, which don't have to go through a rigorous testing or approval process, so the health claims are not guaranteed.
"Some brands label the dosage of probiotics, but it only states the amount 'at time of manufacturing,' not when the consumer purchased or takes it," says Rachel Daniels, MS, RD Sr. and the director of nutrition at Virtual Health Partners. "Probiotics are fragile and to stay alive they need to be at a certain temperature, humidity and level of light. Companies cannot control all of these factors from the time of manufacturing to transport, to the time of sale, so it is difficult to guarantee how many bacteria are alive once you open your container."
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How to choose your probiotics
Another big issue is that most people look for how many many CFUs are in the probiotic bottles they're buying. (CFU stands for colony-forming unit, which refers to the number of live and active micro-organisms that can be found in each serving of the probiotic you're taking.) Most probiotics are mix of multiple strains, but more isn't always better — it's actually the combinations that matter.
"Many of these combinations have never been clinically studied and make unproven claims," says Dr. NavNirat Nibber. "Most formulas are a guess work in compilation of the greatest number of different strains in the highest number per capsule to impress the consumer e.g. 12 strains delivering 20 billion CFU. The reason most companies put in such large numbers is because they have no clinical data that these combinations of strains are compatible, survive or produce any effect. The hope is that by incorporating such high amounts at least some will end up surviving. Some of these combinations have no history of use and these individual strains may be antagonistic to each other and, worse still, may alter the gut flora in an undesirable way. In addition not all probiotics can withstand the harsh stomach environment to reach the large intestines."
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How do you know if you're getting the best probiotics?
First off, go for brands that use clinical studies to formulate their products. "It's also important to look for a probiotic that contains prebiotics and pharmaceutical grade ingredients and to choose a probiotic that has been lab tested to ensure the probiotics in the product can actually reach your small intestine," says Axelrod. Buying DNA-verified is also something to consider as it means a third party has tested the products to confirm what it says on the label is what's in the bottle.
Further, many people spend a premium to buy refrigerated probiotics, but if refrigeration is missed at a specific step between manufacturing and a consumer purchasing it, the bacteria will die. "You also have to wonder, if these bacteria can't survive if not refrigerated how are they going to make it alive to your bowels?" says Dr. Faramarzi.
Looking for somewhere to start? Some brands that have come up in speaking with a number of experts include: The Nue Co. Debloat Food + Prebiotic, Probiogen and Seed.
Image via @thenue_co
