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Choosing the Right Probiotics Can Be Difficult

Ever heard of the phrase “paradox of choice?” (sometimes also called “tyranny of choice.”) It refers to feeling overwhelmed, even paralyzed, into indecision by having too many choices to choose from. There have been best-selling books and TED talks on it. Some economists apparently now doubt whether this is a real phenomenon – but they probably don’t live with IBS and have never been faced with choosing a probiotic!

Probiotics are plentiful

Have you faced down the shelves at the Natural Grocer or Whole Foods? Or worse yet, Googled something like “best probiotics for IBS?” Hundreds and hundreds of brands and sellers, all with competing claims of superiority. Plus, you can get it: gluten-free, dairy-free, sugar-free, vegan, kosher, organic, complete, optimal, ideal, balanced, pharmaceutical grade, doctor-formulated, and money-back guaranteed! For women, for children, for seniors. Oh my!

Reviews are, of course, helpful. As people with chronic conditions, we love to share info. (That’s why we’re here, right?) I take into consideration the number of reviews and like to see a mix of high, medium and low. Why? Because I know that what works for one person doesn’t necessarily work for someone else. So, if all the reviews are positive, I’m skeptical.

How do you decide on a probiotic?

You could ask your doctor. I did. My primary care doctor tried to be helpful. She suggested I try eating more yogurt. I reminded her I’m lactose intolerant.

Most doctors are not experts in probiotics. An international study of more than 1,000 healthcare professionals found that their knowledge of probiotics was just “medium," even though more than 40 percent rated themselves “good” or “excellent.” They had a handle on the basics: The most frequently recognized species of bacteria containing probiotic strains were Lactobacillus acidophilus (92 percent), Bifidobacterium bifidum (82 percent), and Lactobacillus rhamnosus (62 percent).1 These are the bread and butter of probiotics. But recommending a brand? Possibly not.

I worked with my dietitian

For me, I made the decision with the help of a nutritionist. She was helping me determine whether I had any food triggers for symptoms. I had recently received my IBS-M (mixed symptoms) diagnosis, though I’d been suffering with its symptoms for years. My gastro hadn’t given me any information post-endoscopy besides, “oh, it’s just IBS.” But my nutritionist had lots of information and guidance to share how probiotic supplements could help.

She essentially wrote me a short shopping list and recommended that I take it to an independent vitamin store in our city. Armed with that, I was able to talk to an expert at the store who put together a bag of probiotic goodies for me. I’ve tried a couple of different formulations over the years. I’ve tried refrigerated products vs. shelf-stable.

You might be wondering what was on that list. Remember, what works for one person might not work for someone else. But here’s what has helped me for the past decade.

What I take when I get a flare-up

First, when flare-ups occur, or if I come down with stomach flu, I take something to restore the gut flora: Saccromyces boulardi (which is actually a yeast, not a probiotic) for 2 weeks – it’s not meant to be taken long term, according to my nutritionist.

What I take for maintenance

Then, a daily maintenance probiotic that keeps me regular and also helps me avoid vaginal yeast infections, something that plagued me for years. It has two kinds of probiotics:

Lactobacillus strains

  • Lactobacillus acidophilus
  • Lactobacillus rhamnosus
  • Lactobacillus brevis
  • Lactobacillus casei
  • Lactobacillus gasseri
  • Lactobacillus plantarum

Bifidobacterium strains

  • Bifidobacterium lactis
  • Bifidobacterium longum
  • Bifidobacterium bifidum

Trial and error with probiotics

I tried several different brands recommended by the independent vitamin shop – my advisor there set up a schedule for me to take and try each for a few weeks. To my surprise, I really did feel a difference between different brands.

Eventually, I settled on a brand that had strains I was looking for and is shelf-stable: RenewLife Ultimate Flora Women’s Care Probiotic. (Note: I am not compensated for mentioning the name!) It’s available in different CFUs, or colony-forming units, which is the number of live and active micro-organisms: 15 billion, 25 billion, 50 billion or 90 billion.

How many CFUs do you need? My layman’s response: As many as it takes to feel better. RenewLife’s 90 billion product has more CFUs and a few more strains than the other products. It costs considerably more as a result. But I found I didn’t feel any difference in my IBS symptoms or overall well-being when taking the 50 billion vs. 90 billion. On the other hand, I did perceive less effectiveness for me when taking the 25 billion for a while. So, I’ve settled on 50 billion as the best choice for me.

The bottom line is, don’t give up. Don’t be discouraged if the first few things you try don’t give you the results that someone else had. Don’t let yourself paralyzed by all the choices out there, either. Find a knowledgeable person to talk to at a natural grocer or vitamin store and be candid about your symptoms and budget. Good luck and good health!

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