Probiotic + Sb

The useful question isn't "should I take a probiotic?" but "which strain, at what dose, and why that one?" These are the questions our naturopaths ask in store to help you find the right strain.

A good fit if

• You have a specific strain in mind, from a practitioner or your own reading, and want to match it exactly
• You're comparing products and want to judge them on the strains listed and the count at expiry, not the headline billions
• You need a format that suits your life, such as shelf-stable for travel, a powder for a child or a lozenge for your mouth
• You're generally well and adding a probiotic as part of a wider approach to eating well
• You want an Australian listed product, so strain-level labelling and warning rules have been applied

Check with us first if

• You're pregnant or breastfeeding. Some ingredients must carry the statement "Not recommended for use by pregnant and lactating women". It depends on the ingredient, so read the label.
• You take immunosuppressants or immunomodulators. Several Australian probiotic ingredients must carry a warning to talk to a health professional first.
• You're taking antibiotics. One permitted ingredient must be labelled to take it 2 to 3 hours apart from them, and another to talk to a health professional first.
• You're giving a probiotic to a baby or young child. Some ingredients aren't permitted under 2 years, one warns against use under 3, and some say "Not suitable for children".
• You have a short bowel, an ileostomy or colostomy, inflammatory bowel disease, or a heart valve condition.
• You have small intestinal bacterial overgrowth, or your symptoms get worse with fermentable foods.
• You have a severe dairy allergy or a yeast allergy. Both the carrier and the organism matter.
• You're buying from an overseas website. Those products aren't TGA-regulated for quality or strain identity, so the strain may not be what the label says.

• Refrigerated multi-strain capsule. Best known for: The practitioner-style format, usually with the highest declared counts. Absorption: Keeping it cold protects the live organisms. Counts fall faster at room temperature. Typical use: Daily, kept in the fridge. Ask whether it was kept cold in transit.
• Shelf-stable multi-strain capsule. Best known for: Travel, work and anywhere a fridge is not practical. Absorption: Made to hold its count at room temperature. Look for a count guaranteed at expiry. Typical use: Daily. The practical choice when a fridge product would sit for hours in a bag.
• Spore-forming Bacillus. Best known for: Handling heat and acid, because the organism travels dormant and wakes up later. Absorption: Survives storage and stomach acid better than most active bacteria. Typical use: Australian medicines may use only specific named Bacillus strains, declared on the label.
• Saccharomyces boulardii. Best known for: Being a yeast rather than a bacterium, and the only yeast in common use. Absorption: Not affected by antibacterial antibiotics, which target bacteria, not yeasts. Typical use: Sold on its own rather than blended into a multi-strain formula.
• Powders and sachets. Best known for: Babies, small children and anyone who cannot swallow a capsule. Absorption: Mix it into cool food or liquid. Heat kills the organisms, so hot drinks defeat the purpose. Typical use: Measured by scoop or sachet, with the count stated per serve.
• Oral lozenges. Best known for: The mouth and throat rather than the bowel. Absorption: Made to dissolve in the mouth, so swallowing one whole misses the area it is meant for. Typical use: Only two Streptococcus salivarius strains are allowed here, both named on the label.
• Fermented foods, gummies and drinks. Best known for: Live cultures as part of everyday eating, or a format children will accept. Absorption: Counts are usually not stated. Pasteurisation, sugar and long room-temperature shelf life work against the live cultures. Typical use: Good habits, but not a substitute for a named strain at a dose that has been studied.

Reference values. There aren't any. Probiotics are live micro-organisms, not nutrients, so the NHMRC Nutrient Reference Values don't cover them. There's no RDI, EAR or Adequate Intake for any strain, and there's no such thing as a probiotic deficiency.

Typical supplemental range. Most Australian labels give 1 to 10 billion CFU per dose, and some give 50 billion or more. Published studies have used one million to ten billion CFU a day. The number to match is the dose used in research on the strain you're holding, not the biggest figure on the shelf.

Upper level. There's no NHMRC Upper Level of Intake. Instead, Australia caps some species at the strain level: 6 billion CFU a day for Bacillus coagulans MTCC 5260 and 2 billion for MTCC 5856; 5 billion for adults and 1 billion for ages 2 to 17 for the permitted Bacillus subtilis strain; and 0.5 billion for Pediococcus pentosaceus. These are conditions for listed medicines, not safety ceilings.

Worth knowing. CFU stands for colony-forming units, which means organisms that are alive and able to multiply. It tells you how many, but not which strains are there, whether they've been studied, or whether that count will still be there by the expiry date. International scientific guidance says a label should state the minimum number of live organisms for each strain at the end of shelf life, not at manufacture, and give storage instructions. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Yoghurt with live cultures: usually Streptococcus thermophilus with a Lactobacillus species; look for 'live' or 'active'
• Kefir: A fermented milk drink carrying a broader mix of bacteria and yeasts than most yoghurts
• Unpasteurised sauerkraut and kimchi: live only if refrigerated; shelf-stable jars have usually been heat-treated
• Miso and tempeh: fermented soy foods; miso is added off the heat, since boiling kills the cultures
• Aged and traditionally made cheeses: some carry live cultures, though the count is neither declared nor consistent
• Fermented foods generally: none declare a strain or a count, so none is interchangeable with a defined strain at a studied dose

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• You are severely or critically ill, or your immune system is significantly weakened. Blood infections from the bacteria or yeast (bacteraemia and fungaemia) have been reported, so don't take it.
• You have a central venous catheter (central line) or are in intensive care. Don't take it.
• Premature and hospitalised newborns. This is a decision for the hospital only. In 2023 the US FDA received reports of an infant death and over two dozen adverse events.
• Pregnancy and breastfeeding. Some ingredients must carry the warning 'Not recommended for use by pregnant and lactating women', so read the label.
• You take immunosuppressants or immunomodulators. Several probiotic ingredients must carry an Australian warning about this.
• You are taking antibiotics. One ingredient must be labelled to take it 2 to 3 hours apart, and another to check with a health professional first.
• Children. Some ingredients are not allowed under 2 years, one warns against use under 3, and some carry 'Not suitable for children'.
• You have short bowel, an ileostomy or colostomy, inflammatory bowel disease, or a heart valve condition.
• You have small intestinal bacterial overgrowth (SIBO), or fermentable foods make your symptoms worse.
• You have a dairy or yeast allergy. Both the carrier and the organism matter.
• Fever, chills or feeling unwell all over. Stop taking it and get medical advice promptly.
• Products from overseas websites. They are not regulated by the TGA for quality or strain identity.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.