What Are the Best Probiotics?

*This is the next is a series of posts summarizing my research of common ME/CFS supplements and trying to determine the consensus best dosage, and best brands.  Keep in mind, I have no medical background or training, so the goal is just to sort out conflicting internet information and find a common nexus.

People take probiotics for a wide variety of reasons.  There are 2 or 3 reasons for PWMEs to take probiotics.  First, probiotics boost the immune system as a whole.  The gut is the immune systems' first line of defense, and probiotics promote a healthy gastrointestinal tract.  Second, since many PWME's have compromised immune systems, they also have candida overgrowth.  The proliferation of "good bacteria" in probiotics tends to crowd out the candida yeast.  Finally, probiotics help treat IBS and other GI tract problems that are common to PWMEs.  

What Is the Best Brand of Probiotics for PWME's?

Apparently, different strains of probiotics are effective for different symptoms.  Some are better for immunity, and others are better for IBS, etc.  I wasn't interested in trying to determine the best brand for each symptom.  Rather, I wanted to determine which brand was recommended most often for general treatment of a wide variety of symptoms--especially since PWME's usually don't just have one symptom.  For more specific information on buying probiotics, see this article.  

My method was to review as many probiotics rating sites and message boards to learn which brands were recommended the most often.  Is it possible that some of the rating sites are actually paid advertisements?  Yes, but I tried to use common sense to detect and avoid obvious paid ratings.  For instance, one brand was rated #1 on one website, and not mentioned in any other ratings.  On the other hand, if a brand consistently rated in the top 5-10 on most lists, but not always #1, I gave that brand more credit.  When you think about it, who would pay to have their product ranked #7 on a list of 10?  Also, at least one rating site is operated by a non-profit organization, so I gave that website more credence.  

One of the brands that I saw ranked consistently high was Ultimate Flora.  For example, it ranked 1st here, 2nd here (the non-profit rating), and 3rd here.  A few people in the Amazon reviews section said it gave them unpleasant side effects, but the same is true of just about any product reviewed on Amazon.  Two other brands that I frequently saw rated highly were Jarro Dophilus, and Nutraelle.   

[1/16/13 edit:  Ultimate Flora offers many different formulations, but I've learned to stay away from their "Critical Care - 50 Billion" formula, or anything with more than about 15 Billion cultures.  I crash from these extra-strong probiotics, and get major shortness of breath.  Others I've talked to said the same thing.  The right amount seems to be anywhere from 5 to 15 Billion.]

Interestingly, the three best selling brands on Amazon aren't necessarily the most highly rated.  The best selling brands, according to this article are: Align, Acidophilus Pearls, and Threelac. (5/12/12 update: A friend of mine strongly recommends Threelac, and says that some of his PWME friends also call it their favorite.)

Do Probiotics Need a Protective Coating?

Acidophilus Pearls are marketed as having a protective "pearl" coating that ensures the bacteria inside survive your harsh stomach acids long enough to get to where they're needed: your intestines.  But is this necessary, or merely a marketing strategy?  Honestly, I couldn't find the answer to this question.  None of the ratings sites that I reviewed mentioned this feature, but ME/CFS specialist Dr. Teitelbaum seems to lend credence to this claim.  Then again, many PWMEs are skeptical of Dr. Teitelbaum's recommendations.  So, if anyone has more information on this issue, please let me know in the comments section and I will update this post.

The Nuclear Option

I mentioned above that I was also going to review message boards for recommendations on probiotics.  Unfortunately, I didn't find much of a consensus on this topic.  Recommendations were all over the place, with one exception.  This thread from Phoenix Rising includes several endorsements for a super probiotic called VSL3.  It contains about 500 billion living bacteria per dose, which is about 10 to 50 times the typical dose of other brands.  It is also extremely expensive, at $86 per packet of 30.  

[4/25/12 update:  My negative experience with VSL3 is written about here.]

My Choice

Speaking for myself, I do think that probiotics are an important part of my treatment, especially with my high candida antibodies.  My doctor agrees.  I decided to try Ultimate Flora, but at the same time, I can't completely dismiss the "protective coating" claim made by Acidophilus Pearls.  Since most brands' dosage recommendation is 1-3 tablets per day, I decided to hedge my bets and take two different brands.  So I'm taking the pearls in the morning and Ultimate Flora at night.  I will, of course, update this if/when I can tell if it's working.  

[8/23/12 update:  I've been reading more and more about the importance of rotating brands of probiotcs, i.e., taking one type until the bottle runs out, then switching brands, and so forth.  The theory is that the natural state of the gut has many different species of good bacteria living in balance.  Since every brand of probiotics has different combinations of bacteria, if you stick to just one brand, you could get an unbalanced gut that is dominated by the few species of bacteria that happen to be in your chosen brand of probiotics.  Again, I don't know if this theory is true, but it makes logical sense to me.]  

[2/28/13 update:  Dr. Amy Yasko recommends rotating probiotics daily.  She recommends having 3-7 brands on hand and taking a different one every day.]