Probiotics: Foods vs. Supplements and Trend vs. Necessity

A common question from my clients is: 'Should I be taking a probiotic pill?'  Let's start with what even is a probiotic and where do I get it from?

Probiotic means 'for life'.  It is categorized as a functional food, or a food that supplies components (nutrients) that contribute to reducing disease and/or the risk of developing them.  Probiotics are bacteria strains that have beneficial effects on humans and animals.  So what are the benefits?  Well, the list is quite long:
Improvement in intestinal function
Stimulation of the immune response
Production of B vitamins, specifically folic acid
Restoration of intestinal flora after rounds of antibiotics
Treatment for diarrhea caused by certain viruses
Cholesterol reduction
Help with yeast infections, urinary tract infections, allergy symptoms, inflammatory bowel disease, and cancers of the GI tract.

There are hundreds of different probiotic supplements out there, but there is also a cost-effective alternative to buying probiotic pills: fermented foods!  In my opinion, consuming fermented foods is a better way to get your daily dose of these 'friendly' bacteria.  Things like raw sauerkraut, homemade pickles, homemade yogurt, kefir, buttermilk, and kombucha.  These truly functional foods are foods produced and preserved by mircoorganisms.  Why are fermented foods better than just taking a pill?  Another list!:
It will probably cost you less money
The bacteria in these foods are live and active
Fermented foods don't use any heat
The nutrients are more bioavailable in your body with a fermented food
Foods also provide you with other nutrients and phytochemicals
You'll get a wider variety of beneficial bacteria strains than you would in a pill
They are stomach-acid resistant

Like many vitamin and mineral supplements, probiotic pills pose other challenges as well.  They are under-regulated so there creates some uncertainty about what you are actually buying.  With the FDA, probiotics fall into 4 categories: food, food additive, supplement, and drug.  This equates to there not being a single voice on the issue.  Lastly, probiotics are delicate live bacteria.  They can die during processing, packaging, or even while being stored on the shelf.  

That being said, not all supplements are created equal and there are some viable brands out there.  Here are 2 that I like:
VSL-3 for serious cases of IBS, ulcerative colitis, immune disorders
BlueBiotics Ultimate Care

When buying any probiotic supplement, there are certain things you want to look for:
Make sure it contains multiple strains of bacteria - including Acidophilus, Lacto-sporogenes, and Bifidum.
Look for 10 billion CFUs (colony forming units), at least.
Refrigerate after opening.
The probiotic activity should be guaranteed throughout the production, storage, and shelf-life of the product.

A home test that you can do to test the strength of your probiotic is to add the pill to a 4 oz. glass of cold milk.  Leave out at room temperature for 24-48 hours.  If the milk curdles or becomes like yogurt, it's viable!


Sources:
Prado, F.C., Parada, J.L., Pandey, A., et al. (2008). Trends in non-dairy probiotic beverages. Food Research International, 41 (2), pp 111-123.
Hoffman, D.E., Fraser, C.M., Palumbo, F.B., et al. (2013). Probiotics: Finding the right regulatory balance. Science, 342 (6156), pp 314-315.