By Larry Newman
Chief Operating Officer
Technical and Regulatory Affairs
Kirkman Group, Inc.
It is well known that probiotics are one of the most important product categories used for special needs individuals, and the popularity and usage of this product type is growing significantly based on numerous clinical studies that have recently been published in medical literature.
Many consumers, however, are not really familiar with the benefits of probiotics and what improvements they can make in their health. In addition, consumers are often confused as to which probiotics to use and how to administer them.
I have put together a list of the common questions that our customers ask me about probiotics. The questions and answers should help clarify any questions you may have about this valuable product group.
Q: Why would I consider personally taking or giving my family probiotics?
A: Probiotics provide good insurance for maintaining healthy intestinal flora, which in turn supports a healthy gastrointestinal tract. Specific health symptoms that might indicate a need for probiotics include: abdominal pain, gas, bloating, bacterial or yeast overgrowth, constipation or excessively loose stools. In addition, recent double blind placebo controlled studies done by the Public Health University of Texas and Tongi University in Shanghai, China, showed that regular use of probitics improved the immune response in children shortening illness duration and reducing fever, absences from school and the need for antibiotics.
Q: What is the definition of a probiotic?
A: Probiotics are live strains of beneficial bacteria that promote gastrointestinal health.
Q: What are the functions of probiotics?
A: Probiotics promote intestinal growth and colonization of the healthy beneficial strains they deliver, which in turn helps to crowd out harmful bacteria or yeast.
Q: What are the mechanisms by which probiotics deliver their beneficial effects?
A: The probiotics deliver live, colony forming units to the intestines. Generally speaking, Lactobacillus strains work predominately in the small intestine while Bifidobacterium strains are more active in the large intestine and also in very young children. After reaching the intestines, the colony forming units begin multiplying, thereby crowding out and making it more difficult for harmful bacteria to survive.
Q: What are the different functions of the different strains?
A: There are certain strains of probiotics that are particularly effective in crowding out specific strains of harmful bacteria such as Clostridia or Klebsiella. Unless your doctor has positively identified the harmful strains via a stool culture, however, most individuals who use probiotics don’t actually know which harmful bacterial strains are present in the intestines and rely on a multi-strain probiotic to increase the beneficial flora while crowding out the undesirable flora. If your doctor has done a stool test and identified a particular pathogenic bacterium, s/he can prescribe a specific strain of probiotic particularly effective for that organism.
Q: Is there any one strain (or multiple strains) that is more advantageous than others?
A: If a stool test has identified a particular pathogenic bacteria, then a probiotic specifically effective on that bacteria would be desirable. If not, then a combination of Lactobacillus strains and Bifidobacterium strains has been shown to be very effective.
Q: Do I need to start out slowly?
A: Yes. Each individual needs to find out their optimum dose for their own ideal gastrointestinal health. Some individuals need only low doses to correct intestinal issues while others need more therapeutic dosages.
Q: Is the dosage dependent on the patient’s weight or age?
A: It can be, but not necessarily. Each individual needs to find that “ideal” dose. Sometimes once daily is enough, while in others, multiple dosing per day is needed.
Q: What is the rate at which you should increase the dosage?
A: A good rule of thumb is to start out with ¼ of a capsule for a few days, and then increase to ½ capsule if no negative effects (such as loose stools) are seen. After another few days, increase to a full capsule. If improvement is noticed, but not yet optimal, then multiple dosing per day or multiple capsules can be tried. The most common symptoms of overdosing with a probiotic are excessively loose stools or excess gas. If that occurs, back the dosage down.
Q: What kind of beneficial effects have some people seen with probiotics?
A: Reduced abdominal pain, less gas, improved regularity, firmer stools, less odorous stools and better food digestion. Sometimes improvement in skin tone is also seen. Improved immune response is another potential benefit.
Q: Are there any sorts of effects that appear negative?
A: Only if the product is overdosed, in which case loose stools and excessive gas could result — or if there is a die-off reaction resulting from harmful bacteria releasing toxins as they die. This is known as the Herxheimer reaction, which causes the individual to feel “sick” or uncomfortable for a few days. This die-off reaction usually resolves in a week to ten days.
Q: What do you do if you see these effects?
A: If you see positive effects, try to find the ideal dose and maintain that dosing regimen. If the above negative results occur, back the dosage down until the right dose is determined, or, in the case of a die-off reaction, reduce the dose until the situation resolves.
Q: Although probiotics are not intended to diagnose, treat, or cure any disease, for what reasons have some people started taking probiotics?
A: Specific health issues that might indicate a need for probiotics include: intestinal or abdominal pain, gas, bloating, bacterial or yeast overgrowth, constipation or excessively loose stools.
Q: How long will it take to see positive results?
A: Often positive results will be seen within a day or two. In some individuals, it may take a week or two.
Q: Is it possible to overdose on probiotics?
A: Yes. Excessive probiotics usually result in loose stools and/or excess gas.
Q: How do you work with the dosage/administration for a child who has trouble tolerating probiotics?
A: A child who has difficulty tolerating probiotics could have a sensitivity to something in the product or could be experiencing a die-off reaction. If it appears to be a sensitivity type allergic reaction, try a hypoallergenic form. Kirkman’s probiotics are all hypoallergenic. If it appears to be die-off, reduce the dose and be patient. Die-off usually resolves within a week.
Q: How far do probiotics survive in their journey down the gastrointestinal tract?
A: Kirkman’s probiotic strains are stabilized with a protective polymer that coats the probiotic cells to protect them from stomach acids. Most of the cells reach the intestines alive and are ready to go to work. This may not be true of many other brands. Unstabilized strains can be killed off by the acidic conditions of the stomach.
Q: How should Kirkman’s probiotics be stored?
A: Kirkman’s probiotics are shipped on ice. When received by the customer, they should be stored in the refrigerator.
Q: How long can Kirkman’s probiotics be out of the refrigerator (at room temperature) and still be effective?
A: They can be left at room temperature not exceeding 75 degrees Fahrenheit for a day or two. In excess of 75 degrees, however, the integrity of the product can be compromised within about two hours. The hotter the temperature, the quicker cells are killed off. The best scenario is to keep them refrigerated, in which case, label potency is guaranteed through the “Best By” date on the label.
Q: Are Kirkman’s probiotics casein- and gluten-free?
A: All probiotics manufactured by Kirkman® are tested and certified to be casein-, gluten- and soy-free. Kirkman® also distributes, but does not manufacture other brands of probiotics. These other brands are not always free of casein and gluten.
A: The SCD original diet required only Lactobacillus strains to be used. Bifidobacterium strains were not SCD-legal. Using that strict definition, only Kirkman’s Lactobacillus acidophilus product would be considered SCD-legal. Many doctors, however, realized the need for some Bifido strains when on that diet and asked Kirkman® to come up with an inulin free Pro Bio Gold® formulation. We have done that and doctors using that philosophy also consider the inulin free product SCD-legal.
Q: I’ve heard negative things about Bifidum bacteria – one probiotic strain. Are there any particular strains that might cause problems?
A: Kirkman® feels that the negative reports on Bifidum strains are unfounded. It is well established that infants have a very high concentration of Bifidum strains and infant probiotics are usually primarily Bifidum based. Adults, however, also need some Bifido bacteria in balance with Lactobacillus strains for good gastrointestinal health. The literature indicates that multi-strain combinations of Lactobacillus and Bifium strains are more effective than single strains unless a particular bacterium is being targeted.
Q: Do probiotics help the immune system?
A: Yes. Probiotics stimulate the production and activity of immune cells located in the tissues that line the gastrointestinal tract, respiratory system and urinary tract. These are known as mucosal tissues and a significant percentage of the body’s immune capacity may reside in these tissues. Probiotics also contain varying amounts of DPPIV enzyme, which stimulates immune response on the brush border of the gastrointestinal tract.
Q: What is the role that probiotics play when a patient has been prescribed antibiotics?
A: Antibiotics are not specific to harmful bacteria. They also kill off the beneficial flora in the gastrointestinal tract, which often results in severe stomach cramping and diarrhea. By using a probiotic concurrently with antibiotics, beneficial flora can be preserved, which results in minimal side effects from the antibiotic.
Q: How far apart should probiotics and antibiotics be spaced so that both are effective and helpful?
A: The probiotics should be given half way between the antibiotic doses so the two do not come in direct contact with each other. For example, if your antibiotic is to be given every four hours, give the probiotic two hours after the antibiotic. If the antibiotic is to be given every eight hours, give the probiotic four hours after the antibiotic.
Q: Should probiotics be taken before or after any given dose of antibiotics?
A: It is advantageous to take probiotics continuously when using antibiotics, however the probiotic should be given as far apart from the antibiotic as possible as explained in the previous answer.
Q: Have people who have colitis, Crohn’s Disease, or irritable bowel syndrome reported good effects with probiotics?
A: Yes, considerable medical literature indicates that probiotics can improve and positively support the above conditions.
Q: Is there a best time of day to take probiotics?
A: There are two schools of thought on this subject. Some experts suggest taking them on an empty stomach with water, so implantation is more effective, while other experts suggest taking them with meals so that less stomach acid is encountered. Kirkman® recommends taking them at the very beginning of a meal with water, which limits the degree of acidity the probiotic encounters.
Q: Should probiotics be taken apart from digestive enzymes?
A: Probiotics can be partially digested by digestive enzymes such as protease and amylase. For this reason, Kirkman® recommends separating them to some degree. When both products are being used by an individual, we recommend taking the enzyme at the very beginning of the meal followed by the probiotic about 30 minutes later. That way they do not come into direct contact with each other.
Q: Should probiotics be taken apart from any herbs, spices, or herbal supplements?
A: Many herbs contain inherent immune supporting ingredients which can kill living cells such as probiotics. For that reason, herbal products should be given separated from probiotics by an hour or two.
Q: Do probiotics help with nutrient absorption?
A: Intestinal inflammation and/or bacterial overgrowth can interfere with nutrient absorption. When these conditions are present, probiotics can certainly help.
Q: Are different potencies of probiotics generally used in different situations?
A: Generally speaking, one should use the dose of probiotics necessary to maintain good gastrointestinal health. Some people do well on low potency products such as 20 million colony forming units, while others require in the hundreds of thousands of colony forming units. Individuals must find the dosage that is right for their bodies. Also, when significant bacterial overgrowth is present in an unhealthy gut, sometimes therapeutic dosages are needed initially, followed by a maintenance dosage after the overgrowth is reduced.
Q: Do all brands of probiotics need to be refrigerated?
A: The answer to this should be a loud “YES,” however, some manufacturers advertise that their brand is stable without refrigeration. A study done by Bastyr University in 2003 revealed that brands of probiotics which were purchased from retailers off of refrigeration contained little or no activity. Kirkman® has performed independent laboratory testing which supports the Bastyr findings. Consumer Labs has also tested probiotics and has reported many products of questionable quality in the marketplace. No probiotic can withstand the extreme temperatures that are often encountered in shipping, warehousing and hot climates. Manufacturers must be very diligent in all aspects of production to ensure quality. Heat and humidity control of raw material transit, storage, manufacturing and packaging conditions, and warehousing conditions are monitored by Kirkman® to ensure product quality and potency through the best by date when stored by customers at refrigerated temperatures.
Q: Once I start probiotics, do I have to take them forever for them to be effective?
A: No. Once gastrointestinal flora are restored to a healthy state, many individuals can reduce the dosage to every other day, twice per week or a similar reduced dosage schedule. Sometimes probiotics are only given during a specific gastrointestinal condition such as a bacterial infection, which when cleared up will allow the probiotic to be stopped. When it comes to probiotics, every individual is different. You must find your own dosage and schedule which keeps your gastrointestinal tract and immune system healthy.
Kirkman® trusts that these questions and answers will clear up how, why and where to use probiotics, and alleviate some of the common misconceptions about this important product category.
Kirkman offers the following products to support your gastrointestinal health:
Acidophilus Probiotic Powder – Hypoallergenic – Supports gastrointestinal health.
Bifido Complex™ Advanced Formula – Hypoallergenic – Provides “friendly” flora to support intestinal good health and functioning.
CD-Biotic™ – Designed to control difficult bacteria strains and support gastrointestinal health.
Culturelle® – Supports gastrointestinal health with Lactobacillus.
Lactobacillus Acidophilus – Hypoallergenic – Provides L. acidophilus, the primary friendly lactic acid bacteria in the gastrointestinal tract.
Lactobacillus Duo™ – Hypoallergenic – Provides L. acidophilus, the primary friendly lactic acid bacteria in the gastrointestinal tract.
Multi-Flora Spectrum™ – Hypoallergenic – Intensive care formula that provides high potency, broad spectrum support for gastrointestinal health.
Pro-Bio Defense™ – Includes probiotic strains in Kirkman’s popular Pro-Bio Gold™ plus Saccharomyces boulardii.
Pro-Bio Gold™ – Hypoallergenic – Supports the immune system and gastrointestinal health.
Pro-Bio™ Chewable Wafer – Easy to take probiotic wafer that offers broad-spectrum coverage to support the immune system and gastrointestinal health.
Pro-Bio Inulin Free™ – Hypoallergenic – Promotes Intestinal Health
Pro-Culture™ – Hypoallergenic – Supports the immune system and gastrointestinal health.
Saccharomyces Boulardii – Supports the immune and gastrointestinal systems.
Super Pro-Bio™ 75 Billion – Bio-Max Series – Hypoallergenic – Supports good intestinal health and flora and immune response.
Threelac™ – Helps defend against Candida and fungal overgrowth.