I have spent a considerable amount of time researching over the past few months on probiotics. Probiotics are supplements that contain the types of bacteria normally found in a healthy digestive tract. These bacterial strains such as Lactobacillus and Bifidobacterium are found everywhere in our environment and help to keep our digestive tracts healthy. They help us to digest our food, create important vitamins such as the B-vitamins and Vitamin K, and make many minerals more bio-available such as iron and calcium. They also help our bodies to detoxify and eliminate toxic metals such as mercury, aluminum and lead. From the moment we are born these billions of bacterium establish themselves in our gut and work together with our body in a mutually beneficial way. In fact, over 90% of the genetic material found in the human body comes from these microorganisms!

Unfortunately, over the past century or so we have drastically changed our relationship with these microbes. Instead of beneficial bacteria many of us have opportunistic and pathogenic microbes in our gut such as Clostridia, Candida, Staphylococci, and more. Instead of beneficial vitamins and nutrients these pathogens create harmful chemicals and toxins that clog up our body and overload our detoxification systems.

In order to restore the balance of microbiota in the intestinal system it can be helpful to use a therapeutic grade of probiotic as a supplement. There are many probiotic products out there on the market and a good many of them are an unfortunate waste of money. Here are some of the most important features I look for in a good quality product.
  • At least 1 billion bacteria per gram. If it doesn't say how many bacteria - don't bother.
  • Contains no FOS, Inulin, or other sugar - This is a hotly debated point as most probiotics on the market use these polysaccharides in the belief that it is beneficial. The problem is these sugars can feed bad bacteria as well as it can good bacteria. I'd rather go without to be safe.
  • Contain only one form of beneficial bacteria - Bacteria are competitive so unless they have found a way to keep them separated, they will compete and kill each other off and you may not be getting as much live bacteria as you thought.
  • In a powdered form - Although capsules are more convenient for many I like to have the powder because there are less fillers and other potential ingredients that can feed pathogenic bacteria. Powder is also better for using with small children, for topical application, and for use in an enema kit. If the culture is strong enough you don't need to worry about having enteric coating to survive the stomach acid.
  • Not dairy-free - when bacteria are cultured outside the human body the choice of growth medium is important. Certain strains produce their beneficial byproducts only when cultured in milk. For those that are lactose intolerant, the amounts should be small enough and converted quickly enough by the bacteria into lactic acid that it will not cause problems. If it does - you may want to first try using fermented foods in your diet such as homemade sauerkraut.
  • It is a normal inhabitant of the intestinal tract - While some companies seem to prefer spore-form soil bacteria there are other researchers that feel these forms can be harmful. I prefer to stick to the most obvious and proven beneficial forms.
  • Other good qualities: Freeze-dried to preserve viability, not centrifuged or ultrafiltered, and is kept refrigerated at all times.
Below are the products I recommend most at Elder & Sage and how they can be used:

Superdophilus Dairy Powder from Natren - Lactobacillus Acidophilus is the primary bacteria found in the small intestines. This is a super strain that adheres well to the gut wall. This is what you want to supplement with if you have nutrient absorption problems, anemia, food sensitivities, auto-immune diseases, allergies, indigestion, heartburn, gas and bloating, and other digestive complaints. Start with 1 billion bacterium per day and gradually increase to a therapeutic dose of 15-20 billion. A maintenance dose is typically half of the therapeutic dose although it may vary per individual. Children ages 4-10 should receive no more than 12 billion per day.

Bifidonate Dairy Powder from Natren - Bifidobacteria Bifidophilus is the primary bacteria found in the large intestines, urinary tract and genital area. Supplement with this if you have colitis, Irritable Bowel, Diverticulitis, hemorrhoids, Constipation, Diarrhea, cramping pains in the abdomen, yeast infections, jock itch, prostatitis, frequent urinary tract infections, vaginitis and other reproductive disorders. Start with 1 billion bacterium per day and gradually increase to a therapeutic dose of 15-20 billion per day. A maintenance dose is typically half of the therapeutic dose although it may vary per individual. Children ages 4-10 should receive no more than 12 billion per day.

Life Start Dairy Powder from Natren - Bifidobacteria Infantis is the primary strain found in a healthy infant's digestive tract. This should be used for children up to the age of four years that were born by caesarean, not breastfed, received antibiotics either during birth or afterwards, have frequent ear infections and illnesses, have eczema, allergies, acid reflux, colic, food sensitivities, autism, ADD, ADHD, and more. For an infant up to 1 year of age begin with a small amount and increase to no more than 1-2 billion bacterium per day. Ages 1-2 should use no more than 4 billion per day and 2-4 years should have no more than 8 billion bacterium per day as a therapeutic dose. A maintenance dose is typically half the therapeutic dose.

Trenev Trio Capsules from Natren - This product contains three super strains of bacteria in one product. The bacterium are kept separate by using an oil-matrix that carries them past the stomach acidity and releases them in the small intestine as the oil is emulsified  by bile. This product contains a high amount of bacterium and so should be used with caution if you have chronic digestive issues. Use one capsule daily if you are currently on antibiotics or have recently been on them; have been under extreme stress; have experienced a "tummy-bug" or recent food poisoning; or would like to boost your immune system to fight off illness.

As you supplement with probiotics it is not unusual to have a "die-off" reaction as the chemical byproducts of the beneficial bacteria kill off the pathogens in your gut. This can cause fatigue, aching, an off-color feeling, gas, bloating, diarrhea, and other digestive discomforts. This reaction typically lasts no more than a few days to one week. Hold at your previous level of probiotic until the symptoms subside.

To Your Health!
Dr. Kathryn


Pam T.
12/03/2011 5:21pm

Have you heard of Prescript-Assist? Our GAPS practitioner sells them.

01/07/2012 7:11am

When does one transition from a therapeutic dose to a maintenance dose?

02/08/2012 1:26pm

Thank you both for your comments. I'm sorry it has taken me so long to respond! Pam, I am familiar with prescript-assist although I have no clinical experience with it and I would say that as long as your GAPS practitioner feels confident with that product and has seen good results than stick with it.
Kim, you can transition to a maintenance dose after being on the therapeutic dose for about six months as long as all digestive symptoms are gone.

02/29/2012 2:56pm

A couple questions, please.

So would you then NOT recommend Dr. McBrides Bio-Kult since they say it has 14 strains (obviously more than 1) of beneficial bacteria?

Plus it includes Bacillus subtilis, a catalase-positive bacterium commonly found in soil.

Also, isn't the gut supposed to have many strains of beneficial bacteria? How do you introduce them, one at a time? If they compete and kill each other off, don't they do that in your gut?

Sorry but I'm a newbie to all of this. Please forgive me my many (and maybe nonsensical) questions.

03/15/2012 1:19pm


I recommend what has worked for me in my practice as Dr. Natasha suggested. Many other GAPS practitioners have used and recommend Bio-Kult but I avoid it because it is grown on a soy medium. I prefer the single strains of L. Acidophilus and B. Bifidophilus because those are the strains that are found in abundance within the digestive tract. I've found that as long as these strains are dominant they allow for the existence of the minor strains which are supplied through fermented foods. Because bacterial strains are competitive you never know which ones are becoming dominant in the gut. I believe a minor strain in a dominant position can still be harmful.
The L. Acidophilus I suggest to supplement with before bedtime so they can act of the food from dinner in the small intestine where they prefer to live. The B. Bifidophilus I recommend first thing in the morning when the small intestine is empty so they can act on the food remaining in the large intestine where they prefer to be.
I hope that makes sense!

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