Health Tips

Wanna hear a disgusting (but also kinda cool) scientific fact? Each of us have trillions of microorganisms in our body — outnumbering human cells by 10 to 1. 

It is as if each of us is a planet and the trillions of microorganisms are the inhabitants of the planet. And just like we have bad and good people on the planet earth, our body also constantly interacts with the “good” and “bad” microorganisms.

Image showed Lactobacillus acidophilus, a strain of probiotics. Image via Doc. RNDr. Josef Reischig, CSc., CC BY-SA 3.0 , via Wikimedia Commons

Probiotics are the “good guy”, so to speak. The International Scientific Association for Probiotics and Prebiotics (yes, we have an international association for probiotics) reached a consensus in 2014 that defined probiotics as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (i.e you!)”.

There are various strains of probiotics, the common one are Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, Escherichia, and Bacillus. Depending on the strains and amount, different probiotics products may offer different benefits from one another.

It’s important to remember that probiotics must be consumed alive to have health benefits. They can die during the food manufacturing process or during their shelf life.

Benefits of Probiotics

We went in-depth into the scientific evidence of the health benefits of probiotics in this article. To summarize, probiotics are known to offer two major benefits: a healthy gut and a good immunity. 

A healthy gut

The use of probiotics to maintain a healthy gut is supported by many substantial scientific evidence that based on a body of available research, including high-quality meta-analyses, on a diversity of digestive-related conditions (such as persistent diarrhoea in children, acute infectious diarrhoea, antibiotic-associated diarrhoea, gut transit, IBS, abdominal pain and bloating, ulcerative colitis and necrotizing enterocolitis). 

A good immunity

The benefit of using probiotics to achieve good immunity is thought to be strain-specific. However, “a good immunity” could also mean a lot of things; it could mean preventing allergies, reducing inflammation or enhancing the ability of your immune system to fight infection. Therefore, unlike its benefit in maintaining a healthy gut, the scientific evidence on probiotics supporting a good immunity is overly broad. Experts generally agree that probiotics are good for immunity, but depending on which aspect of the immune system you’re talking about, different probiotics strains may offer a variable degree of benefits.

Other benefits

Other benefits such as supporting the health of the reproductive tract, oral cavity, lungs, skin and gut–brain axis are promising, but evidence has not yet been linked to a broad enough cross-section of probiotics to consider that all probiotics products will demonstrate these benefits. In other words, more studies are required.

Sources of probiotics

Now that we know the benefits of probiotics, then where can we obtain them? In modern days, one can obtain probiotics via two sources: food and dietary supplements.

Food

"Probiotic Drinks" by Jepster is licensed under CC BY-NC-SA 2.0

Particularly fermented food! Manufacturers make yogurt, for example, by adding live microorganisms (such as Lactobacillus or Streptococcus) to milk. But whether the microorganisms provide probiotic benefits depends on the types and amounts added. 

Secondly, how you process the food may also affect the probiotics inside. Some fermented foods (such as sourdough bread and most pickles) that are processed after fermentation can kill the probiotics. Other fermented foods such as apple cider vinegar, cheese, kimchi, kombucha, miso, and sauerkraut have not been studied, so whether they have any probiotic benefits is not known. 

Nowadays, many manufacturers also add probiotics into unfermented food, such as baby milk formula and some cereals. Nevertheless, their probiotic benefits are very much depending on the types and amounts of probiotics, as well as if the probiotics have been killed during the manufacturing process.

Dietary supplements

Photo by Julia Zolotova on Unsplash

Probiotics are also available as dietary supplements in the form of capsules, powders and liquids. You can find them in any pharmacy outlet. 

Probiotics supplements often contain a wide variety of strains (as opposed to 1-2 strains in food products) and doses. The dose of probiotics supplements are measured in colony forming units (CFU), which indicate the number of probiotics that are alive (called “viable cells”). Amounts may be written on product labels as, for example, 1 x 10^9 for 1 billion CFU or 1 x 10^10 for 10 billion CFU. Many probiotic supplements contain 1 to 10 billion CFU per dose, but some products contain up to 50 billion CFU or more. 

However, higher CFU counts do not necessarily improve the product’s health effects. Taking 50 billion CFU does not mean that you gain 5 times more benefits than the 10 billion CFU products. As we mentioned above, only probiotics that are alive can bring you benefits, so you should look for products labeled with the number of CFU at the end of the product’s shelf life, not at the time of manufacture. (Probiotics may die during their shelf life)

The benefits of many probiotics supplements have not been examined in research studies, and it is difficult for people not familiar with probiotic research to determine which products are backed by evidence. Consult a healthcare provider you trust and get him or her advice on choosing the most suitable probiotics supplements for you. 

Difference between probiotics in food and in dietary supplements

If you’re convinced of the benefits of probiotics, and would like to ensure adequate intake, should you get it from food or dietary supplements?

Amount and types of probiotics

Dietary supplements contain more strains and amounts of probiotics than their food counterparts. For example, yogurt brand Yakult and Yakult Light are fermented milk drinks containing one strain only called Lactobacillus casei Shirota per 65ml bottle. In contrast, a probiotic dietary supplement Thc Lacto-5 500mg contains 5 local strains with up to 10 billion CFU probiotics per capsule.

Manufacturing process

The manufacturing process of probiotics supplements may be different from the manufacturing of food that are added with probiotics. This discrepancy may in turn affect the stability of probiotics and the amount of probiotics that are alive in the product. The probiotics in yogurt usually do not survive when they reach our stomach and might not resist degradation in our small intestine. As a result, only little probiotics arrive at our distal gut and get absorbed. Whereas manufacturers of probiotics supplement deploy various technologies to increase the survival of probiotics, such as freeze and dry spraying, pre-conditional stress test and optimized growth conditions.

That being said, do consult a healthcare professional for choosing the best quality of probiotics supplement. This is because not all probiotic supplements are created equal – some of them failed to deliver the stated viable probiotics after ingestion, and some even contained undesired microorganisms inside.

Different regulation

Food that contains probiotics such as yogurt are being regulated in Malaysia under Food Act 1983 & Food Regulation 1985. On the other hand, probiotics supplements are being regulated under Control of Drug and Cosmetics Regulation 1984 and Drug registration Guidance Document (DRGD) by National Pharmaceutical Regulatory Agency (NPRA). This means that the manufacturer of yogurt complies with a different act and guideline than the manufacturer of a probiotic supplement. 

Generally speaking, the regulation of pharmaceutical products such as a supplement is more stringent. This is also why you would find a MAL registration number and a Meditag hologram sticker on a legally registered probiotic supplement (which is required of every supplement product in Malaysia) but not on your yogurt. If any of your supplements do not have both, do not buy them as they are not registered with NPRA.

This is how a meditag hologram looks like:

Image credit https://ansarcomp.com.my/index.php/2019/06/04/how-to-identify-medicine-that-are-registered-with-moh/

Probiotics are not the only things you need

Probiotics supplement certainly can provide more high-quality probiotics, but we need to be reminded that probiotics are not the only nutrients we need. This is why we should not abandon food-source probiotics completely, because these foods contain tons of amazing nutrients such as prebiotics, vitamins and minerals. These are the gems that probiotics supplement lack of.

So, which one should you take?

Currently, there are no official recommendations for probiotic use by healthy people. Both food and probiotics supplements have their own virtues. The most appropriate thing you can do is to consult a healthcare professional and ask for advice about which probiotic to choose, what dose to take, and how long to use the product. Your healthcare professional should be able to answer you based on your health status, nutritional needs and your health goal. There’s no one size fits all solution when it comes to nutrition, there’s only what works best for you.

Don’t wait until it’s too late. Check your health condition here.

References

1. World Gastroenterology Organisation Global Guidelines - Probiotics and prebiotics Feburary 2017

2. NIH - Probiotics Fact Sheet for Health Professionals

3. Health and Medicinal Food Regulation in Malaysia

4. The Production and Delivery of Probiotics: A Review of a Practical Approach

5. Charalampopoulos, D. and Rastall, R., 2009. Prebiotics and probiotics science and technology. New York: Springer Verlag.

Cover image credit: Photo by Julia Zolotova on Unsplash

Written by

Ms Joyce Toh