How to help your patient choose the right probiotic

With an increasing amount of attention surrounding gut health and its impact on overall health and wellbeing, as a healthcare professional, you may have been asked by your patients how they can better care for their gut health. This could potentially include questions on whether they should take a supplement such as a probiotic.

Whilst the solution to gut health is not a ‘one size fits all approach’, there is a growing body of evidence demonstrating the critical role of the gut microbiome in both health and disease and probiotics can play a key role in impacting gut bacteria¹

As defined by the World Health Organization (WHO), probiotics are “live microorganisms that when administered in adequate amounts confer a health benefit on the host”.² However, with so many probiotic supplements on the market, it can be difficult to know which one is best suited to your patient’s needs. In fact, a survey of 1360 healthcare professionals including Dietitian, Paediatricians and Gastroenterologists, highlighted that only 45% reported a good or excellent knowledge of probiotic, with 91% of them expressing a need for more education.³

In this article, we'll discuss how healthcare professionals can choose the right probiotic for their patient, evaluating factors such as dosage size, strain selection and quality control standards which should all be considered when deciding which probiotic product to recommend.

1. Confirm safety and efficacy

When choosing probiotics for a patient, it is important to ensure that the product is safe and effective. Therefore, before recommending probiotics, healthcare professionals should verify the safety of the probiotic.

It is crucial to select probiotics that have been tested and proven as safe for consumption. To ensure the probiotic supplement arrives alive in sufficient amounts to effectively colonize the gut, check labels on products for the number of colony forming units (CFU) guaranteed until the end of their shelf life, not at manufacture time.⁴ This is because probiotics must be consumed alive in order to provide optimal benefits and they must be protected from external factors such as certain temperatures throughout their shelf life.

Additionally, healthcare providers should evaluate the scientific evidence available to support specific microbial strains, multi-strain combinations and/or products against the patient’s reported symptom profile or condition.

2. Depend on dosage

For optimal gut health, probiotics can be an effective means of rebalancing the immense microbial population that lives in our intestines. It’s staggering to think that there are up to 1000 different species of bacteria, virus and fungi co-inhabiting our gut with each of our microbiomes unique to us as individuals.¹

Taking probiotic supplements should involve careful consideration by healthcare professionals. They must contain adequate amounts of colony forming units to offer a real benefit and research has shown that higher doses often carry more significant results. In fact, in various clinical trials, a dose-response has been observed, resulting in a higher dose being associated with increased benefit to the recipient.⁵

3. Diversity is key

Alongside a healthy, varied and balanced diet rich in fibre and non-digestible carbohydrates, choosing a multi-strain polybiotic with a diversity of well-researched microbial strains has the potential to offer additive, if not synergistic benefits. For healthcare professionals looking to recommend probiotics, there is ample evidence suggesting that a diverse gut microbiome is the key to achieving optimal health.

A comprehensive analysis published in 2022 concluded that those with chronic diseases have lower microbial diversity compared to healthy individuals. Thus, it makes sense for healthcare providers to suggest probiotic supplements comprising of multiple strains and naturally occurring non-digestible carbohydrates for their patients, to potentially attain greater benefits.⁶

4. Prioritise patient preference

When it comes to probiotics, healthcare professionals must consider many factors to ensure their patients get the best option for their lifestyle. Probiotic supplements come in various forms; from capsules, sachets and bottles, liquid presentations, or freeze-dried powders. Subsequently, to make sure probiotics are easy to incorporate into your patient’s day-to-day routine, palatability, format and acceptability should be taken into account. 

To summarise, when selecting a probiotic supplement for your patients, the key elements to consider include safety, scientific evidence backing its efficacy, survivability in the digestive tract, a probiotic's ability to colonize the gut, dosage amount, diversity of strains present within the probiotic, and acceptability by your patient.

References:

1. Wilson Z. and Whitehead K. Clin Nutr ESPEN 2019 Dec;34:104-109. https://pubmed.ncbi.nlm.nih.gov/31677699/
2. Rowland I. et al. Eur J Nutr 2018; 57(1): 1–24.
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847071/
3. Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria. Food and Agriculture Organisation (FAO) of the United Nations, World Heath Organisation (WHO) 2001.
4. National Institutes of Health. Probiotics. Fact Sheet for Health Professionals Probiotics - Health Professional Fact Sheet (nih.gov)
5. Ouwehand AC. Beneficial Microbes, 2017; 8(2): 143-151
   https://pubmed.ncbi.nlm.nih.gov/28008787/