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Question: I am curious why some probiotics do not require refrigeration even though they contain some of the same bacteria in probiotics that require refrigeration? Which probiotics need to be refrigerated?
Answer: Proper refrigeration is critical for many probiotics, both before and after they are purchased. In fact, in 2009 the majority (85%) of probiotics selected for testing by ConsumerLab.com did not contain their listed amounts of organisms and, as ConsumerLab.com later learned, improper shipping and warehousing by distributors and retailers appears to have been at least partly to blame. Fortunately, ConsumerLab.com found better results in early 2012 (17% of products failed testing), probably due to improvements in refrigeration procedures by several companies.
Many probiotic bacteria are naturally sensitive to heat and moisture. Heat can kill organisms and moisture can activate them within pills, only to die due to lack of nutrients and a proper environment. These products should ideally be refrigerated and kept out of humidity. However, probiotics with freeze-dried organisms (which includes most sold as supplements in tablet or capsule form) and in packaging to prevent moisture, such as blister packs, generally do not need refrigeration or to be kept out of humidity but should still not be exposed to heat above room temperature. They also have longer shelf-lives than products containing live cultures, such as yogurts and drinks (which must be refrigerated). Probiotic yeast and some of the spore-forming bacteria, such as Bacillus coagulans, generally do not require refrigeration.
If you are purchasing a probiotic with a label that suggests or requires it be refrigerated, be sure your retailer has kept it refrigerated. If you order the product by mail, such as from an online retailer, be sure it is shipped overnight or with refrigerated shipping to minimize exposure to extreme heat, especially during warm weather - and arrange for the package to be delivered at a time you are home. (Freeze-dried probiotics are not damaged by extremely cold temperatures, like the temperature in airplane cargo holds, which can reach freezing or below - so they can be safely shipped by air.)
Once you get the product, be sure to follow the manufacturer's recommendations. If in doubt, refrigerate. Once you remove a probiotic from its blister pack or container, use it right away - don't put it in a weekly pill holder.
Question: Are enterically coated supplements better than non-enterically coated ones?
Answer: Enteric coatings help protect supplement ingredients from being released in the stomach and keep them away from stomach acid and enzymes. This allows the supplement to stay intact until it reaches the less acidic small intestine (where most nutrient absorption takes place). An enteric coating may also be desirable for ingredients which, for some people, otherwise cause an unpleasant aftertaste. Consequently, with ingredients that need protection it is sometimes worthwhile to purchase an enterically coated supplement. However, enteric coatings are not always necessary or beneficial, and, in some case, may just be an expensive gimmick. There are also some concerns about enteric coatings of which you should be aware. See the full answer (with information about enteric coatings for fish oil, marine oils, probiotics, garlic, and SAMe)>>
Question: When is the best time to take probiotics to prevent diarrhea from antibiotics - before, during, or after the course of antibiotic treatment?
Answer: As discussed in more detail in the Probiotic Supplements Review, probiotics can be taken starting the first day of oral antibiotic treatment and continued for 2 weeks after the completion of antibiotic therapy. It may be advisable to take probiotics and antibiotics at least 2 hours apart to reduce the possibility of the antibiotic killing the probiotic organisms. For more details about the types and amounts of organisms which have been shown helpful in reducing the risk of antibiotic-related diarrhea see the Probiotic Supplements Review >>
Note: If diarrhea occurs when taking an antibiotic and persists for several days, see a physician. Severe cases of C. difficile-associated diarrhea, for example, can be life-threatening.
Question: Have you heard of the probiotic, Keybiotics? Does it do what it claims, and is it worth the money they charge?
Answer: Keybiotics is a branded probiotic blend promoted as "the most powerful probiotic supplement ever created." The suggested daily serving, one 500 mg capsule, claims to contain 14 probiotic bacterial strains. Although it does not break out the amount for each strain, it claims to provide a total of 37.5 billion colony forming units (CFU). (The recommended intake for probiotic supplements varies by strain and use, but tends to be about 1 billion to 10 billion CFUs per day.) While the type and amount of healthy bacteria in this product is certainly in line with what ConsumerLab.com recommends when choosing a quality probiotic supplement, there is not enough evidence to deem Keybiotics the "most powerful" probiotic on the market. Keybiotics is also not among the probiotics tested by ConsumerLab.com to verify its contents.
The bacterial strains in Keybiotics include Bifidobacterium lactis, which has been shown to be helpful for diarrhea and irritable bowel syndrome, Lactobacillus plantarum, which may be helpful for cold and flu, Lactobacillus rhamnosus, which may be helpful for vaginal infections, Lactobacillus casei, Lactobacillus salivarius, Lactobacillus bulgaricus, Bifidobacterium breve, Lactobacillus paracasei, Lactococcus lactis, Streptococcus thermophilus, Lactobacillus brevis, Bifidobacterium bifidum and Bifidobacterium longum. (Bifidobacterium longum has been shown to reduce anxiety, especially when taken with Lactobacillus helveticus R0052; however, Keybiotics does not contain Lactobacillus helveticus R0052.) You can learn more about the effects of these individual strains in ConsumerLab.coms summary of evidence in the Review of Probiotic Supplements.
Keybiotics also claims to contain Lactobacillus acidophilus DDS®-1, a strain described on the Keybiotics website as "the most versatile and effective probiotic currently available" which "outperforms virtually any other strain." The company maintains that this bacterial strain helps you stay regular and bolsters the immune system. Lactobacillus acidophilus DDS®-1 has been shown in vitro to inhibit H. pylori, a bacterium associated with stomach ulcers, and to stimulate immune system cells, but more studies in humans are needed. One clinical study did establish that this strain survives well in the digestive tract, although not as well as Lactobacillus casei, another strain included in Keybiotics. (Interestingly, the same study noted that these strains did not survive long-term in the digestive tract, but became undetectable 8 days after subjects stopped taking them, suggesting that these bacteria need to be taken on an ongoing basis to maintain a benefit).
It should be noted that Lactobacillus acidophilus DDS®-1 is available in other probiotic supplements which have been tested and reviewed by ConsumerLab.com. In fact, a number of probiotic supplements available on the market provide a similar number and variety of bacterial strains as offered in Keybiotics, and in doses of up to 900 billion. Keybiotics sells for about $30 for a 30-pill bottle, putting the cost per pill at $1. While this is within the range of prices for comparable products, less expensive products with a similar amount and range of bacteria, and which have passed ConsumerLab.com testing, are available at about half the cost.
The bottom line:Keybiotics brand probiotics lists a good variety of potentially beneficial bacterial strains. Although the total listed dose seems reasonable, the amounts of specific bacteria are not listed, making it difficult to gauge the applications for which it may be most useful. In addition, there do not appear to be published clinical studies about this particular blend of probiotics to support the claim that it is the most powerful probiotic. Similar strains and blends are available in a number of other probiotic supplements which cost less and have been tested by ConsumerLab.com. (ConsumerLab.com may test Keybiotics in the future.)
Question: Can probiotics help lower cholesterol?
Answer: Yes, certain probiotics, such as Lactobacillus reuteri NCIMB 30242 (Cardioviva) and E. faecium M-74, have been shown to modestly lower LDL ("bad") cholesterol levels in people with elevated cholesterol, although they do not raise levels of HDL ("good") cholesterol. For details about these probiotics, dosage, and potential concerns, see the What It Does section of the Probiotic Supplements Review>>
Question: The probiotic I am taking looks pink. Does this mean it is spoiled or no longer "active"?
Answer: The probiotic material in powders, capsules and tablets is usually white or off-white. However, some probiotic strains can interact with preservatives used in a supplement, resulting in a pink color, which is not harmful and does not indicate that the probiotic is spoiled or inactive. For more information, see the Probiotic Supplements Review >>
Question: Which supplements have been shown to be helpful for autism?
Multivitamins and minerals -- These are one of the most widely recommended supplements by physicians for children with autism. One randomized, double-blind, placebo-controlled study involving 141 children and adults with autism found supplementation with a specially formulated liquid multivitamin/mineral (see ingredients and amounts here) which also contained CoQ10, MSM and N-acetylcysteine (NAC), improved the nutritional and metabolic status of children with autism, and significantly reduced symptoms such as hyperactivity and tantrums (Adams, BMC Pediatrics 2011). The supplement was given in three equal doses at breakfast, lunch and dinner. For more about multivitamins, including our most recent product tests and reviews, see the Multivitamin Supplements Review >>
Melatonin -- Many children with autism have difficulty falling asleep or staying asleep. In fact, an estimated 50% to 80% of children with autism spectrum disorders may suffer from sleep difficulties or insomnia (Malow, J Autism Dev Disord 2013). Several studies have found individuals with autism to have lower levels of melatonin or melatonin metabolites than those without autism (Rossignol, Dev Med Child Neurol 2011). An analysis of 18 studies of people with autism (mostly children between the ages of 2- 18, although two studies included individuals over the age of 18) found that melatonin supplementation (in doses ranging from 0.75 mg to 25 mg daily) significantly improved the time it took to fall asleep and sleep duration, and, in some individuals, also improved daytime behavior (Rossignol, Dev Med Child Neurol 2011). Another study also found that a daily dose of 1 mg or 3 mg of melatonin improved sleep latency in children with autism spectrum disorder (Malow, J Autism Dev Disord 2013). For more about melatonin, including our most recent product tests and reviews, see the Melatonin Supplements Review >>
Probiotics -- Children with autism can experience significantly more gastrointestinal symptoms, including diarrhea, constipation and abdominal pain, than others (McElhanon, Pediatrics 2014), and probiotics may be helpful for some of these symptoms.
Because abnormal gut microbiota and gastrointestinal dysfunction in children with autism has also been associated with increased irritability, tantrums, aggressive behavior and sleep disturbances, researchers have proposed further study of the use of probiotics (Critchfield, Gastroenterol Res Pract 2011). One interesting, preliminary animal study found a specific bacterial strain, Bacteroides fragilis, improved gut permeability and autism-like behaviors in mice (Hsiao, Cell 2013). For more information about specific strains used to reduce abdominal pain, and our most recent product tests and reviews, see the Probiotic Supplements Review>>
N-acetylcysteine (NAC) -- This amino acid has been found to reduce irritability, but not other symptoms, in children with autism (Hardan, Biol Psychiatry 2012) and in children taking risperidone (an atypical antipsychotic drug sometimes prescribed for people with autism) (Ghanizadeh, BMC Psychiatry 2013). The dose in these studies ranged from 900 mg to 2,700 mg daily, which was generally well tolerated. (ConsumerLab.com will be testing NAC supplements later in 2014).
L-carnosine -- An 800 mg daily dose of L-carnosine for 8 weeks in children with autism was found to significantly improve scores on the Gilliam Autism Rating Scale in a small clinical study (Chez, J Child Neurol 2002).
L-carnitine -- One preliminary clinical trial found that L-carnitine, taken daily (50 mg per kg bodyweight) as a liquid supplement, significantly improved clinical measures of autism spectrum disorder in children (Geier, Med Sci Monit 2011).
Ubiquinol -- Some research on autism has proposed oxidative stress as a potential cause of neuronal dysfunction and clinical symptoms in autism (Gvozdjakova, Oxid Med Cell Longev 2014). Ubiquinol, which is the active form of CoQ10, taken at 50 mg twice per day, at morning and lunchtime, for three months, was found to improve communication, sleep, and decrease food rejection in a small study of children with autism, based on parental reports (Gvozdjakova, Oxid Med Cell Longev 2014). The authors noted that in the first days of supplementation, a small subset of children had increased anger, hyperactivity or sleep disturbance, which was managed by modifying the timing of the doses to morning and evening. For more about ubiquinol, including our most recent product tests and reviews, see the CoQ10 & Ubiquinol Supplements Review>>
Vitamin C -- One small study found significant improvements in behavior in autistic children who received a high dose of vitamin C (8,000 mg per 70 kg of body weight) daily when compared to placebo. (Dolske, Prog Neuropsychopharmacol Biol Psychiatry 1993). It is important to note, however, that taking such a large dose of vitamin C may cause diarrhea in some people. For more about Vitamin C, including our most recent product tests and reviews, see the Vitamin C Supplements Review >>
See ConsumerLab.com’s Encyclopedia article on Autism for more information about supplements that may or may not be helpful.
Question: Do any supplements help with seasonal allergies?
Answer: Supplements shown to help with seasonal allergy symptoms include butterbur, bromelain, nettle, spirulina and conjugated linoleic acid (CLA). You can learn about the evidence for these supplements, including clinical studies, dosage and more, in the Encyclopedia article about Allergies >>
Preliminary research suggests that some probiotics may also reduce allergy symptoms. When taken with a daily antihistamine, one particular strain of probiotic was found to improve ocular (but not nasal) allergy symptoms. See the Probiotics Review for more information >>
Laboratory research suggests stinging nettle (Urtica dioica) extract may bind to histamine receptors and inhibit certain inflammatory processes associated with seasonal allergy symptoms (Roschek, Phytother Res 2009). There appears to be just one study of its effects in people with allergies, which found that 58% of those who took stinging nettle (reported it to be effective in relieving their symptoms, compared to 37% of those who took a placebo. However, two of the twenty-one people who took stinging nettle dropped out of the study after their symptoms worsened. Participants took 600 mg of freeze-dried stinging nettle leaf at the onset of allergy symptoms and 300 mg as needed for one week (averaging about 3 doses per day) (Mittman, Planta Med 1990).
Preliminary evidence suggests quercetin may help to inhibit the release of histamine, however, there do not appear to be any studies demonstrating its effects on allergy in people.
Be aware that while echinacea may be helpful for colds and respiratory infections in some people, it is not typically recommended for allergy symptoms. In fact, people who are allergic to ragweed, daisies, sunflowers, and other flowers may be more likely to have an allergic reaction to echinacea.
Question: Is it best to take probiotic supplements with or without food? It seems like everyone has a different recommendation.
Answer: Some evidence suggests that when you are using a non-enterically coated probiotic, it may be best to take it shortly before or during a meal. For more details, as well as information about using enterically-coated versus non-enterically coated probiotics, see the Probiotic Supplements Review >>
Question: Once I've taken probiotics for a few months, will the positive bacteria remain in my system, or do I have to keep taking them?
Answer: In general, probiotics will only survive in your system for a limited amount of time. For more details, including how long you should take probiotics for specific uses, dosage, and other tips for taking, see the Probiotics Supplements Review >>
Question: I've seen the bacteria in Activia listed as Bifidobacterium animalis, Bifidobacterium lactis and Bifidus Regularis. Which is correct?
Answer: Bifidus Regularis® is the name trademarked by Dannon for the bacterial strain used in Activia products. For more information about this strain, including other names used for marketing, as well as the official scientific classification, see the ConsumerTips section of the Probiotics Review >>
Question: I eat one to two cups of Greek yogurt every day. Do I still need to take a probiotic supplement?
Answer: Although yogurts, such as Greek yogurt, may be teeming with organisms used as starter cultures (such as Lactobacillus bulgaricus and Streptococcus thermophilus), these are not necessarily “probiotic” organisms, i.e., those which seem to survive passage through the stomach and populate the gut for beneficial effect.
If you want probiotic organisms, you’ll need to get them from a separate product or purchase a yogurt to which probiotic organisms have specifically been added (check the label). Many clinical studies of probiotics in Asia and Europe have, in fact, been conducted with yogurts and other cultured dairy products to which probiotics have been added. You can read about these studies, learn more about probiotics, and see our product test reviews of marketed supplements in Probiotics Review>>
Question: What is Lactospore? I see it is an ingredient in some probiotic supplements.
Answer: LactoSpore is a branded probiotic containing the “sporulating” bacteria Bacillus coagulans. Information about Bacillus coagulans and other probiotic organisms, including different species and strains of Lactobacillus and Bifidobacterium, plus clinical evidence, dose, and products which contain these probiotic organisms, is found in the Probiotics Supplement Review >>
Question: I have low blood pressure. Are there any supplements I should avoid?
Answer: Certain supplements can cause decreases in blood pressure and should be used with caution if you already have low blood pressure. These are melatonin, arginine and large doses of magnesium. Calcium may also cause a very small decrease in blood pressure. Preliminary studies have found black cohosh may lower blood pressure in animals, but it is unclear whether it has this effect in people.
There are also a number of supplements that have been shown to lower blood pressure in people with hypertension (high blood pressure). These include CoQ10, fish oil and omega-3 fatty acids, garlic, potassium, flaxseed, certain strains of probiotics, and green coffee bean extract. While much of the evidence for these is focused on people with high blood pressure, they could potentially lower blood pressure in others. So, if you take one of these supplements and find your low blood pressure becomes even lower, try eliminating the supplement and see if your blood pressure improves.
For more about using these supplements, including the evidence, potential side effects, and our tests of products, use on the links above.
Question: How do I choose the best probiotic supplement? There are so many different strains of bacteria!
Answer: Since the effects of individual bacteria strains vary, the first thing to consider when choosing a probiotic supplement is the reason you are taking it. Certain strains, for example, may help with weight loss, lower cholesterol or reduce allergy symptoms, while others have been shown to help with digestive issues, such as diarrhea from antibiotics and irritable bowel syndrome. The uses and evidence for various strains are summarized in a reference table in the Probiotic Supplements Review (be aware that certain strains should be avoided by people with milk allergies or people taking certain medications).
Once you have identified the right strain or strains, it's important to find a product that provides a dose that's been shown to be effective, and that contains it's labeled dose (ConsumerLab.com tests have found some probiotic supplements to contain less than half the amount of organisms claimed on the label!) To get test results for popular products, plus additional tips for choosing a probiotic supplement, see the Probiotic Supplements Review >>
Question: Do any supplements help relieve stress?
Answer: Fish oil may blunt some of the effects of mental stress, such as increased heart rate and nervous activity. Several clinical studies show ashwagandha may help to relieve symptoms in people with anxiety. And, interestingly, a particular probiotic has been shown to lower levels of the "stress" hormone cortisol, and measures of psychological distress such as depression and anger.
L-theanine, an amino acid found in black and green tea, has been shown to reduce stress responses without causing drowsiness, and there is some evidence that the herbs passionflower and lemon balm may be helpful for anxiety.
One clinical trial found 500 mg of holy basil leaf extract taken twice daily significantly reduced measures of anxiety in men and women (Bhattacharyya, Nepal Med Coll J 2008). See the Encyclopedia article about Ayurvedic medicine for other uses for this herb - which is listed by its scientific name, Ocimum sanctum.
Ginseng is sometimes promoted for reducing stress, although one clinical study found it did not have an effect on cortisol levels. There is weak evidence that valerian supplements may produce a calming effect in stressful situations.
Be aware that low blood levels of iron and vitamin B6 have been associated with stress responses such as hyperventilation and panic attacks in women (Mikawa, Acta Med Okayama 2013), so be sure you're getting sufficient intake of these nutrients. There is some evidence that daily supplementation with a multivitamin-multimineral supplement may help people to cope with stressful situations.
For more information, use the links above, and see the Encyclopedia article about Stress.
Question: Is it true that NAC can help clear nasal passages?
Answer: Although NAC has mucus-thinning properties when directly inhaled, there is little evidence that oral supplementation can reduce the thickness or volume of nasal congestion. More about this is found in the Review of NAC (N-Acetyl Cysteine) Supplements.
If you are suffering from nasal congestion due to a cold, taking a zinc lozenge may reduce the duration of nasal discharge and nasal congestion if taken within 24 hours of onset of symptoms.
Certain probiotics have also been shown to reduce the duration of cold symptoms such as a runny nose.
Question: Do probiotics that come in different forms, like gum or lozenges, really work?
Answer: There is some clinical evidence showing that probiotic gum or lozenges may be beneficial for conditions affecting the mouth or throat, such as gum disease and throat infections. There do not appear to be studies on their effects on gastrointestinal symptoms, as shown with probiotic pills, drinks and powders. You can learn more about probiotic gums and lozenges, plus evidence of other uses of probiotics, and our tests of popular products, in the Probiotic Supplements Review.
Question: Do any supplements help with gum disease or periodontitis?
Answer: Several different types of supplements may be helpful in improving gum disease and/or periodontitis -- the inflammation around the teeth causing pocketing -- such as DHA from algal oil, gamma-linolenic acid (GLA), lycopene, green tea, cranberry extract, and a certain type of probiotic. For details, including dosage, see the full answer >>
Question: Do probiotics have to be enterically coated to be effective?
Answer: In general, most Lactobacillus, Bifidobacterium, and Streptococcus species of probiotics (all very common in supplements) do not need enteric coating as they can survive passage through the stomach. Although enteric coating may increase the number of cells that survive, there are potential downsides. More details are found in the "Withstanding stomach acid" and "Cautions and Concerns" sections of the Probiotic Supplements Review.
Question: Do probiotics really help prevent or treat vaginal yeast infections?
Answer: Taken orally, certain probiotic strains have been found to reduce bacteria and yeast known to cause infection caused by overgrowth of these organisms in the vagina, possibly helping prevent infections, although one study found no benefit when used during antibiotic therapy. Oral probiotics have not been found to reduce existing yeast infections. There is mixed evidence on whether probiotics in suppository form can help. For more details, including probiotics used and dosage see the Probiotic Supplements Review >>
Question: Which supplements can help to lower blood pressure?
Answer: There are many supplements, including CoQ10, fish oil, curcumin, certain probiotics, cinnamon and others, which may lower blood pressure. However, if you already take medication to lower blood pressure, always consult your physician before using these supplements, as they may lower your blood pressure too much, or interfere in some other way with your current medication. Be aware that a number of supplements can increase blood pressure. Sign in to see the full answer >>
See the Encyclopedia article about Hypertension for more information.
Question: Do any supplements help for irritable bowel syndrome (IBS)?
Answer: Several different types of probiotics have been found to reduce symptoms of IBS, but the appropriate probiotic may depend on whether the IBS is causing predominantly diarrhea or constipation. (See the "What It Does" section of the Probiotic Supplements Review for details.)
Prebiotics have also been promoted for IBS, although the evidence is mixed.
Interestingly, several small studies suggest melatonin may improve symptoms of IBS, possibly by affecting the nervous system in the digestive track. (See the "What It Does" section of the Melatonin Review for details).
Preliminary evidence suggests psyllium, a type of fiber, may be helpful for people with IBS with constipation.
Information about other potentially helpful supplements, including peppermint oil and flaxseed, is found in the Encyclopedia article about IBS.
Be aware that a number of supplements, including fish oil, magnesium, high doses of vitamin C, berberine and turmeric/curcumin can cause diarrhea, so you may want to avoid these or reduce your dosage if you find they are exacerbating IBS symptoms. See the "Concerns and Cautions" section in each review for details.
Question: Can a probiotic help men with prostatitis?
Answer: Prostatitis is an inflammation of the prostate gland. It is sometimes caused by bacterial infection which can either be acute -- typically cured with antibiotics, or chronic -- which is more difficult to treat and occurs more frequently in men with gastrointestinal disturbances, such as irritable bowel syndrome (IBS).
A study among men with chronic prostatitis and IBS found that taking a probiotic along with antibacterial treatment helped reduce the risk of recurrent infection and the progression of inflammation to other glands. Details about this study and probiotic used are found in the "What It Does" section of the Probiotic Supplements Review.
There do not appear to be studies evaluating the benefits of probiotics for acute bacterial prostatitis or for chronic non-bacterial prostatitis — which is the most common form of prostatitis.
Other natural treatments for prostatitis, including quercetin and grass pollen extract, are described in the Prostatitis article in the Encyclopedia.
Question: I developed a rash soon after starting a probiotic. Is it possible to be allergic to probiotics?
Answer: Yes, certain ingredients in probiotic supplements can cause allergic reactions in sensitive individuals -- particularly individuals with milk or yeast allergies. Contamination with mold can also cause an allergic reaction (all probiotic products reviewed by ConsumerLab.com are tested for potential contamination with molds and/or pathogenic bacteria). Inulin, a prebiotic which is sometimes added to probiotic supplements, is also a potential allergen.
Allergens in probiotics are also suspected to cause, on very rare occasion, a serious condition known as eosinophilic syndrome.
For more details about allergic reactions to probiotics, as well as other possible adverse effects, see the Concerns and Cautionssection of the Probiotics and Kefirs Product Review, which includes tests and quality ratings of popular probiotic products. Also be sure to check and compare the ingredients in each tested product, as can be found in the Review's Ingredients Table.
Question: Do probiotics help with lactose intolerance?
Answer: It has not been well demonstrated that probiotics reduce the gas and bloating caused by milk and dairy products in people with lactose intolerance. On the other hand, fermented milk products, such as yogurt and kefir, which contain live organisms (not necessarily "probiotics") have been shown to cause fewer symptoms of lactose intolerance than regular milk containing the same amount of lactose.
Question: Are lozenges and sublingual pills considered dietary supplements?
Answer: Lozenges and sublingual pills are, according the FDA, not dietary supplements if they deliver their contents only to the mouth or throat to exert their effect. (An example of this is noted in an FDA Warning Letter sent to a company marketing a "Zinc & Echinacea" throat lozenge).
Keep in mind that just because a product is sold as a sublingual does not mean that it's been proven to work sublingually. Also keep in mind that the ingredients in lozenges do, of course, make their way into the gastrointestinal tract and can have additional effects once there. For example, while the zinc in zinc lozenges may have a local effect on the throat to reduce cold symptoms when taken at the correct dosage and frequency, ingestion of too much zinc from lozenges can cause one to exceed tolerable intake levels and, over time, have detrimental effects (see the Zinc Supplements and Lozenges Review for more information).
ConsumerLab.com tests lozenges and sublingual pills (such as some vitamin B-12 products) and holds them to the same standards as dietary supplements — making sure they contain what they claim, lack common contaminants, and that tablets will properly disintegrate.
Question: Is the probiotic "Milk Test," as described on many websites, really an effective way to test the quality of the bacteria in probiotic supplements at home?
Answer: Generally not. The "milk test" described on websites will not reliably tell you if a probiotic supplement contains viable organisms or not. The "test" is often described as checking for the formation of curds or clumps a day or two after putting the contents of a probiotic supplement into a small amount of milk and leaving it at room temperature.
It is true that certain probiotic bacteria can cause milk to clump, but not all probiotic bacteria will do this in the "milk test." Clumping in milk is caused when proteins (which are normally free floating) join together when the milk becomes acidic. Certain probiotic bacteria can make milk more acidic by fermenting lactose (milk sugar) into lactic acid — the process used to create yogurt, kefir, and cheese. A significant amount of lactic acid has to be produced to make the milk acidic enough for it to curdle.
Probiotic bacteria which can convert lactose to lactic acid include those of the genus Lactobacillus (such as L. acidophilus). However, another common genus of probiotic, Bifidobacterium (such as B. animalis, also called Bb12), can only do this conversion when little oxygen is present and would, therefore, fail to curdle milk in the "milk test."
Some harmful bacteria, such as species of Streptococcus, can also digest lactose and curdle milk, which could mislead you to believe that only healthful bacteria are present.
The enzyme, chymosin (also known as rennin) can also cause milk to curdle by acting directly on proteins. It is commonly used in making cheese. The "milk test" has been misleadingly used to promote probiotic products in which chymosin has been added as an ingredient because the "test" will show the product to curdle milk relatively quickly. This, of course, does not prove that the probiotic organisms are present and active.
The milk test is also not valid when using tablets which have not been crushed (they are only expected to properly break apart when subjected to heat and agitation, as in the stomach), particularly chewable tablets, or those with enteric coatings which would first need to have their coatings removed. If the probiotic organisms cannot be released and exposed to the milk, they won't be active.
Not surprisingly, ConsumerLab.com does not use the "milk test" in its independent tests of probiotics, which it conducts every two years and publishes online. The products are purchased off the shelf and are tested in expert microbiology laboratories by plating their contents on culture media which is then incubated. The quantity of viable organisms is determined by the resulting growth of bacterial colonies. The products are also tested for possible contamination with mold, yeast, and pathogenic (disease-causing) bacteria, such as E. coli and Salmonella. For ConsumerLab.com's most recent tests of probiotic supplements (as well quality ratings, ingredient and cost comparisons, and information about the clinical uses, dosage, and potential side effects of probiotics) see the Probiotics and Kefirs Review >>
Question: Which supplements can help lower or control my blood sugar?
Answer: Many different supplements may help lower or control blood sugar in people with prediabetes or type 2 diabetes who experience hyperglycemia (when blood glucose rises higher than normal). These supplements are discussed below. More details about each, including dosage, drug interactions, potential side effects, and ConsumerLab.com's reviews of products on the market, can be found by clicking on the links.
Due to the seriousness of hyperglycemia, it is important to consult with your physician regarding use of these supplements.
Cinnamon supplements may modestly improve blood sugar in people with type 2 diabetes whose blood sugar is not well controlled with medication. In addition, one small study found that a branded cinnamon extract reduced fasting blood sugar by an average of about 10 mg/dL in prediabetic men and women with metabolic syndrome. Keep in mind, however, that only certain varieties of cinnamon have been shown to have this effect, and long-term safety studies have not been conducted.
Curcumin (from turmeric) may improve blood sugar levels, according to preliminary studies, and one study found curcumin to dramatically lower the chances of prediabetes in middle-aged, slightly overweight men and women with somewhat higher than normal blood sugar levels.
Alpha lipoic acid may improve insulin sensitivity and blood sugar control in people with type 2 diabetes, although it may only slightly reduce levels of glycosylated hemoglobin (HbA1c).
Chromium picolinate may help some people with type 2 diabetes decrease fasting blood glucose levels as well as levels of insulin and glycosylated hemoglobin (HbA1c). However, be aware that high doses may worsen insulin sensitivity in healthy people who are not obese or diabetic.
Having adequate blood levels of vitamin D may reduce the risk of insulin resistance in people who are obese. There is some evidence that a certain blood level of vitamin D is needed for normal glucose metabolism in women who are overweight and obese (but not diabetic), but it is not clear whether any further benefit is gained with higher blood levels.
In healthy people, consuming a moderate amount of olive oil with a meal has been shown to reduce increases in blood sugar after the meal compared to the same meal consumed with corn oil. In people with type 1 or type 2 diabetes, olive oil may improve glucose metabolism.
Increasing dietary fiber, especially insoluble fiber from cereal and grains, is associated with a reduced risk of diabetes and has been shown to reduce fasting blood glucose and modestly lower HbA1c in people with type 2 diabetes (Martin, J Nutr 2008; Post,J Am Board Fam Med 2012). In people with type 1 diabetes, 50 grams of dietary fiber per day has been shown to significantly improve blood sugar control and reduce hypoglycemic events (Giacco, Diabetes Care 2000). The American Dietetic Association states that "diets providing 30 to 50 g fiber per day from whole food sources consistently produce lower serum glucose levels compared to a low-fiber diet. Fiber supplements providing doses of 10 to 29 g/day may have some benefit in terms of glycemic control." (Slavin, J Am Diet Assoc 2008). Although ConsumerLab.com has not tested fiber products, we have produced a webinar about that provides more information.
Ginseng, both American and Korean Red ginseng (from Panax ginseng), may reduce blood sugar levels in people with diabetes, according to preliminary research.
Drinking whey protein before a high glycemic meal may help to lessen increases in blood sugar after the meal in people with well-controlled type 2 diabetes.
Silymarin, a component of milk thistle, may decrease blood sugar and hemoglobin A1c in people with type 2 diabetes, and reduce insulin resistance in people with coexisting diabetes and alcoholic cirrhosis.
Inulin, a type of prebiotic, may improve measures of blood sugar control in women with type 2 diabetes, although it did not improve blood sugar levels or insulin resistance in a study of prediabetic men and women.
Berberine (a compound found in plants such as barberry, Oregon grape and goldenseal) may reduce blood sugar levels in people with metabolic syndrome or type 2 diabetes, according to a few small studies.
Fenugreek may help to lower blood sugar, according to preliminary studies, and one study found fenugreek extract to significantly improve some measures of blood sugar control and insulin response in people with type 2 diabetes.
White mulberry (Moruns alba or Morus indica) has been traditionally used in Asia to help treat type 2 diabetes, and there is some preliminary evidence to support this use. Mulberry leaf extract (species not given) may lessen increases in blood sugar after ingestion of table sugar in healthy people and people with type 2 diabetes (Mudra, Diabetes Care 2007). Among people with type 2 diabetes, taking 1 gram of powdered white mulberry leaf three times daily (after breakfast, lunch and dinner) for four weeks was found to lower fasting blood sugar by 27%, while taking 5 mg of the anti-diabetes drug glibenclamide lowered fasting blood sugar by only 8% (Andallu, Clin Chim Acta 2001).
There is mixed evidence as to whether CoQ10 may lower blood sugar. To be safe, people with diabetes or who take medication to lower blood sugar should consult a physician before using.
There are a few supplements which may worsen blood sugar control or insulin sensitivity in certain people: excessive amounts of niacin may elevate blood sugar levels, and prescription digestive enzymesmay cause an increase or decrease in blood sugar levels in people with exocrine pancreatic insufficiency. CLA (conjugated linoleic acid), a popular supplement for slimming, may worsen blood sugar control in diabetics and in obese people without diabetes.
Although fish oil does not appear to adversely affect blood sugar levels in people with diabetes, one study reported that a large daily dose of krill oil (providing a modest amount of EPA and DHA) reduced insulin sensitivity in overweight, middle-aged men by about 27% -- which could potentially increase the risk of diabetes.
Also note that high doses of vitamin C may increase blood sugar or interfere with certain blood sugar tests.
Question: With probiotics, how many CFUs should I look for as the dose? Is more necessarily better?
Answer: As a general rule, a probiotic should provide at least 1 billion CFUs (colony forming units, i.e., viable cells), with doses typically ranging between 1 billion and 10 billion CFUs daily for adults. This is explained in the Probiotic Supplements Review, which includes ConsumerLab.com's tests of popular probiotics. There are some exceptions to this: Doses as high as 100 billion CFUs or more are used in some situations, while doses for children and infants are sometimes below 1 billion.
The specific dose will depend on the probiotic strain and the purpose for which it is taken. You can look this up in the "What to Consider When Using" section of the Review, where you will find the dose and strain(s) used in preventing/treating antibiotic-associated diarrhea, IBS, anxiety, depression, allergies, and more. Details about the actual studies are found in the "What It Does" section of the Review.
The following CL Answers may also be of interest to you:
Question: What is the difference between the "Best By" date and the "Date of Manufacture" on a supplement label? How do I know how long my supplement will last before it "goes bad"?
Answer: As explained by ConsumerLab.com's president, Tod Cooperman, M.D. in this New York Times article, the "Best By" or "Use By" date on a supplement label indicates how long a supplement will last before losing potency. Although the FDA does not require supplement labels to provide an expiration date, those which do are required to have stability data to support their claim.
A "Date of Manufacture" simply indicates when the supplement was made, not how long the ingredients remain stable and potent. For more information about this, and how long various supplements remain potent, see the article in The New York Times >>
Also, be sure to take extra care when looking at the date listed on probiotics supplements. Some may list the number of cells in a product as the amount "at the time of manufacture" — a practice which is misleading and violates FDA regulations. You can learn more about this in the "ConsumerTips" section of ConsumerLab.com's Probiotic Supplements Review, as well as in this interview with Dr. Tod Cooperman on Reuter's Health.
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Product Review:Probiotics (for Adults, Children and Pets) and Kefirs
Initial Posting: 11/1/15 Last Update: 9/27/16
What's Really in Your Probiotic (Including Your Pet's) and Kefir?
Find Out Now -- You May Be Surprised!
Probiotic supplements and kefirs compared in this review
21st Century High Potency Acidophilus Probiotic Blend
Garden of Life RAW Probiotics Women
ProBioCare Women's Probiotic
21st Century Ultra Potency Advanced Probiotic
GNC Ultra Probiotic Complex 25
Puritan's Pride ProBiotic 10
365 Everyday Value Probiotic Complex
GNC Ultra Probiotic Complex 50
Schiff Digestive Advantage Daily Probiotic
Bayer Phillips Colon Health
Simply Right [Sam's Club] Acidophilus
BioGaia ProTectis - Lemon
Jarrow Formulas Women's Fem Dophilus
Solgar Probi 30 Billion
Cardioviva Natural Health Probiotic
Latta Russian Kefir 2% Fat
Spring Valley [Walmart] Acidophilus
Lifeway Lowfat Kefir
The Vitamin Shoppe Ultimate 10 Probiotic
CVS/pharmacy Probiotic Acidophilus
Nature Made Digestive Probiotics Daily Balance
Trunature (Costco) Chewable Probiotic
Dr. David Williams Probiotic Advantage
Nature's Bounty Ultra Strength Probiotic 10
TwinLab Triple Action Oral Health Dots
Dr. Mercola Complete Probiotics
Nature's Way Primadophilus Children
UP4 Probiotics with DDS
Essential Formulas Dr. Ohhira's Probiotics
Nature's Way Primadophilus Fortify
Evolve Kefir 1% Lowfat Cultured Milk
Nature's Way Primadophilus Optima
VetriScience Vetri Probiotic Everyday
Nusentia Probiotic Miracle Premium Probiotic Blend for Pet
Vitamin World Probiotic 10
Garden of Life Dr. Formulated Probiotics Women's
Nutrition Now PB8
Garden of Life Primal Defense Ultra
Only Natural Pet Probiotic Blend
Well at Walgreens Super Probiotics
Make sure the probiotic supplement you take passed our tests!
Isn't your health worth it?
Which are the best probiotic supplements and bottled kefirs (cultured milk with probiotics)? This report will help you find out.
If you are taking a probiotic to help with a specific condition, it is important that you first select a probiotic that provides the specific bacteria or yeast shown to help with your condition, such as irritable bowel syndrome (IBS), abdominal pain, infections, diarrhea, cold and flu, and even high cholesterol, anxiety, and weight control. The clinical evidence is provided in this report.
What's more, you need to know proper dosage. The amount of cells provided by probiotic products in this review alone ranged by more than 900,000%, from just a few million per daily serving, to as much as 900 billion!
You also need to know if the product contains its listed amount of viable (living) probiotic organisms. Our tests found some which did not -- containing less than halfof what was listed on their labels. If you own a pet, be aware that one of the three products we tested for dogs and cats had a relatively tiny number of organisms and would seem unlikely to be effective.
Fortunately, we also found many probiotics with the number of organisms they claimed -- typically billions. In addition, we checked to make sure these products were not contaminated with other organisms, such as molds and certain disease-causing bacteria.
Probiotics tend to be expensive, so we show which offer good value
Among kefirs, we found enormous differences in the amounts of live cells by brand. Kefirs are touted as more digestible than milk for people with lactose-intolerance, so we also analyzed their lactose content, and were shocked by our findings — refuting a claim on one the products!
If you are trying to find the best probiotic for your needs, read this report about probiotic supplements for adults and children, and even for dogs and cats. You'll get test results for 43 probiotic products -- 21 selected by ConsumerLab.com for review and 22 others that passed voluntary quality certification testing, as well as information about two supplements similar to one that passed testing. You'll also find out what's in 3 popular kefir products. You'll
Which probiotics supplements and kefirs passed or failed our tests and how many viable cells they contained
Which probiotic bacteria or yeasts have been shown effective for treating or preventing specific conditions, and at what dose. These microorganisms include Lactobacillus acidophilus, Lactobacillus GG, Bifidobacterium infantis, Saccharomyces boulardii, and many others
Price comparisons of probiotics and kefirs
Ingredient comparisons and what to look out for on probiotic labels
Tips on how to use probiotics — and store them to last longer
Concerns, cautions, and potential side effects of probiotics -- including concerns for people with milk allergies
ConsumerLab.com Answers -- for Probiotics (for Adults, Children and Pets) and Kefirs
Question: I am curious why some probiotics do not require refrigeration even though they contain some of the same bacteria in probiotics that require refrigeration? Which probiotics need to be refrigerated? Get the answer >>
Question: Are enterically coated supplements better than non-enterically coated ones? Get the answer >>
Question: When is the best time to take probiotics to prevent diarrhea from antibiotics - before, during, or after the course of antibiotic treatment? Get the answer >>
Question: Have you heard of the probiotic, Keybiotics? Does it do what it claims, and is it worth the money they charge? Get the answer >>
Question: Do probiotics that come in different forms, like gum or lozenges, really work? Get the answer >>
Question: Do any supplements help with gum disease or periodontitis? Get the answer >>
Question: My dog is getting older and his veterinarian recently recommended giving him a glucosamine supplement for his joints. Has ConsumerLab.com tested these, or other supplements for pets? Get the answer >>
Question: Do probiotics have to be enterically coated to be effective? Get the answer >>
Question: Do probiotics really help prevent or treat vaginal yeast infections? Get the answer >>