Eating is certainly not as simple as chew, swallow and repeat. For many shoppers, the digestive process is rarely complete without a few hiccups along the way. Since digestive care may well comprise some of your most sought-after products, make sure you’re up to date on this dynamic category.

What Shoppers Need to Know about Probiotics
Thanks to the deep marketing pockets at some conventional yogurt companies, your shoppers have definitely gotten the message that probiotics are good for digestion. Perhaps it’s time to teach them something they don’t already know.

Know your bugs. For instance, Tim Gamble, president and CEO of Nutraceutix, Inc., Redmond, WA, sets us straight on the terminology framework. In the example Lactobacillus acidophilus XYZ, the genus is Lactobacillus, the species is acidophilus and the strain is XYZ. While it’s unlikely shoppers will want to memorize the differences between the scores of probiotic genera, species and strains available on the market, there is some value in having a top-level understanding of them so as to better guide decisions about what to buy.

For starters, Jay Levy, director of sales at Wakunaga of America, Mission Viejo, CA, says two of the most familiar genera of probiotics live in different parts of the body. Lactobacillus is found in the small intestine, while Bifidobacterium likes to hang out in the large intestine. This could be meaningful to individuals looking for a targeted solution to their digestive care.

“Those with irritable bowel syndrome (IBS) or Crohn’s disease may need a probiotic that contains a specific proprietary strain of Lactobacillus known as LP299v [Lactobacillus plantarum 299v, from Swedish probiotics supplier, ProBi],” he suggests, explaining that this beneficial strain of bacteria is isolated from human intestinal mucosa. Levy says microbiologists have found human strains are better  for supplementation by humans than non-human strains.

“LP299v is capable of surviving exposure to stomach acid, as well as resisting the effect of bile acids in the small intestines. Research also shows that this novel probiotic strain readily adheres to the cells that line the intestinal wall where it proliferates and forms a protective barrier against harmful microbes,” Levy explains. Thus, this strain’s benefits to those with intestinal issues like irritable bowel syndrome (IBS) or Crohn’s can be significant.

The LP299v strain can also be suitable for those with acute digestive distress, if the CFUs are significant. For instance, data from human clinical trials suggests that antibiotics-induced diarrhea, gas or bloating lessened from taking LP299v.

This hits on an important aspect of the probiotics category. As Gamble puts it, the strain is where some companies distinguish themselves with research about a very specific bug.

Greg Leyer, Ph.D., chief scientific officer at UAS LifeSciences, Madison, WI, gives us a great illustration of just how different strains (which are based on bacterial genes) can be from one another. Dogs may all be Canis familiaris, but the Chihuahua and the Great Dane are quite different. “When researchers evaluate probiotics, they conduct their tests with specific strains and the results will not apply to other strains,” he explains.

Susan Hazels Mitmesser, Ph.D., director of nutrition research at American Health, Ronkonkoma, NY, provides another analogy: “Just like different vitamins have individual roles to play in our bodies, each probiotic strain can have different health benefits...Emerging research shows that each strain of a given species can have a different effect in the body; one strain might impact immune function while another has digestive benefits and some can have both.” Some may even be better for kids than others.

Another specific strain (Bacillus coagulans GBI-30, 6086, called GanedenBC30) with its own body of dedicated research is referenced by Michael Bush, senior vice president of Ganeden Biotech, Mayfield Heights, OH. This strain “differentiates itself from other probiotics with its ability to survive the manufacturing processes, shelf life, stomach acids and intestinal bile,” Bush explains.

The reason why, he says, is because of a “naturally occurring layer of organic material (spore) that protects the genetic core of the bacteria. Other probiotics, such as Lactobacillus and Bifidobacterium, are unable to form this protective layer, making them more vulnerable to manufacturing conditions.” So, GanedenBC30 is well suited for a variety of products such as yogurt, bars, tea, nut mixes and more.

Again, this is further evidence why shoppers should understand that each probiotic strain is unique. “Survivability, safety, efficacy and the benefits to the host can differ from strain to strain,” adds Bush.

In addition, certain beneficial bacteria may have specific uses outside the realm of digestive care, and may not be suitable for maintaining gut health at all or vice versa. Gene Bruno, M.S., M.H.S., director of category management at Twinlab, New York, NY, uses the example of a branded Streptococcus salivarius strain (BLIS K12, distributed by Stratum Nutrition of St. Charles, MO), which “has benefits in supporting throat health, ear health and fresh breath. Common probiotics such as L. acidophilus do not offer these same benefits, though they offer other benefits.”

Many times, individuals are looking for all around digestive care, so a multi-strain product may be suitable. Ed Levine, M.D., Connecticut-based board-certified gastroenterologist in private practice and creator of Good To Go, outlines some “powerful strains of probiotics to enhance digestion” within a multi-strain probiotic, which includes L. acidophilus for “maintaining the integrity of your intestinal walls for maximum absorption of nutrients,” B. bifidum for “proper digestion of dairy products,” B. longum to “help break down carbohydrates without producing excess gas” and L. rhamnosus for “reducing occurrences of traveler’s diarrhea.” Others add in B. lactis, too.

Justin D. Krahl, sales manager at Probium, Wausau, WI, agrees that these bacteria species work well together. “The Lactobacillus strains are universal but the Bifidobacterium strains are more specific and that is why I recommend B. longum, B. bifidum and B. lactis,” he states.

Make good on promises. Gamble says identifying the best probiotic for a shopper entails more than just the specific strain. Rather, he believes it “must involve considerations for proper delivery of the organisms to the consumers’ body after, perhaps, lengthy storage in retail distribution and on store shelves.” Therefore, brands and shoppers should be told there could be significant differences in the quality and effectiveness of probiotics on store shelves.

“A capsule labeled as containing 50 billion colony-forming units (CFUs) of probiotics may be (and almost always is) vastly less effective than a 10 billion CFU product manufactured using the latest state-of-the-art delivery technologies that support longer shelf-life and protect fragile probiotic organisms from damaging stomach acids, such that they release properly and alive in the intestinal tract where they can flourish and provide the most benefit,” says Gamble.

As Bush points out, “Vegetative cells are very susceptible to heat, moisture and stomach acid; this means that manufacturers need to be innovative to ensure survival.” For this reason, retailers should be up on the latest ways manufacturers ensure that the CFUs listed on the bottle are what get delivered to the intestines.

As an example of this, Trisha Sugarek MacDonald, B.S., M.S., director of research and development/national educator at Bluebonnet Nutrition Corporation, Sugar Land, TX, says her company ensures the CFUs at the time of manufacture are the same as when the shopper has the product in hand by “following a rigorous standard operating procedure.”

This includes making sure materials are kept cold, right from the shipment from the supplier in a refrigerated truck. “Once raw materials land at the facility, they are immediately put into our large-scale refrigerated rooms until samples can be tested for identity, potency and purity,” she explains. Then, they are encapsulated and put into a refrigerated holding room until finished good testing at a microbial lab is completed. Products are shipped from a refrigerated warehouse (often early in the week to avoid delays on the weekend) to retail in a cold pack.

It’s worth asking your manufacturers what the cold processing and storage situation is like at their facility. Says Leyer, “Keeping probiotics in a very dry, cool state during blending, capsuling and packaging requires specialized production facilities and know-how.” His company is also careful to select the “toughest, most resilient strains to begin with” and employ a rigorous quality assurance process that meets or exceeds the FDA requirements for manufacturing and testing.

Levy’s company has tested its proprietary probiotics processing methods. “Shelf life data collected over more than three years by an independent laboratory has confirmed greater than 109 viable cell counts for each of Wakunaga’s Probiotics. At room temperature (77 ˚F or 25 ˚C), each of Wakunaga’s Probiotics maintained its high viable cell count for three years. L. gasseri has been shown to retain their viability for up to six years at room temperature, according to measurements of retained samples.”

An out-of-the-box solution for maintaining stability comes from Probium, which uses an unusual bottle to protect probiotics from humidity and moisture. Says Krahl, “These bottles ensure that moisture does not affect the probiotics stability, even with multiple opening and shutting of the bottle.” The bottles are made of a special material that actually absorbs moisture and oxygen. Probium pairs this protective bottle with “delayed-release veggie capsules to help ensure the probiotics bypass the acid in the stomach and make it to the intestines unaffected.”

Time-released products pose some specific challenges, and Bruno says his company uses a unique proprietary delivery system (BIO-tract from Nutraceutix) to ensure the probiotics’ viability. “BIO-tract uses a type of pectin that protects the majority of a supplement’s probiotics from gastric acid, helping to ensure that a significantly higher percentage of microorganisms reach the intestines alive,” he explains.

Hazels Mitmesser, whose company also enrobes its probiotics in this vegetarian gel-like substance, adds that the technology “allows the caplet to pass through the digestive tract, and release live organisms at targeted locations within the digestive system.”

Again, the proof is in the lab. Bruno says data on this technology “confirmed that the probiotics are afforded protection through acid exposure and continually release through the testing period in simulation of the passage through the human digestive tract.”

Gamble adds that Bio-tract caplets can be custom developed to “release more quickly or more slowly to target the upper or lower digestive tract, can include any number of suitable probiotic organisms, and can incorporate other digestive health ingredients, immune support ingredients, and many others.”

Missy Lowery, senior manager of marketing at Capsugel, Americas Region, Greenwood, SC, says some companies are using another delayed-release capsule (DRcaps Capsules from Capsugel) to deliver acid- and moisture-sensitive probiotics and even enzymes. The capsules have polymer properties formulated into the low-moisture HPMC capsule that has a moisture level of 4–6% in 50% relative humidity. Gelatin capsules are typically 12–14%, she explains. “To accomplish delayed release, the unique polymer properties formulated within the capsule itself open slowly after swallowing and resist acid in order to protect nutritional ingredients from full release and disintegration in the stomach, thus allowing for complete dissolution in the intestine,” she explains.

This negates the need for enteric coatings, which are a common way of protecting probiotics. Lowery feels the heat and moisture required to make this coating can reduce the viability of the live bacteria if the manufacturer isn’t careful. In addition, she believes consumers may perceive coatings as “unnatural” and prefer a capsule like that described. Also appealing to shoppers, she says, “the innovative polymer properties also mask repeat tastes of ingredients for increased digestive comfort.”

A 2013 independent scintigraphic in vivo study of these capsules suggests they effectively protected their contents from early activation in the stomach. In most study subjects, capsules were completely released in the intestines, “where products such as probiotics and enzymes work best,” Lowery states. Release began approximately 52 minutes after ingestion (when they were just leaving the stomach), which was 45 minutes later than an immediate-release capsule. They completely released the ingredients approximately 72 minutes after ingestion.

Also note that some strains, as mentioned previously, are inherently hardy and don’t require the same kind of delivery mechanism. For instance, Bush says that GanedenBC30 is a “temperature-stable, spore-forming probiotic” with a protective layer around its DNA. This allows it to survive harsh manufacturing processes, heat, cold and the acids of your stomach.”

Likewise, Todd Beckman, COO and co-founder of GoodBelly, Boulder, CO, says LP299V has a “unique ability to survive the stomach’s harsh acidic environment in order to inhabit the intestine.

Thriving in research circles. Space doesn’t permit here for a complete rundown of all the great new research supporting the many ways that probiotics benefit the body. But to cherry-pick some important things your shoppers should know, note that researchers are uncovering more information about the relevance of the body-wide microbiome to our overall health and well-being.

The many benefits of probiotics have support from work conducted through the $153-million Human Microbiome Project. “The project catalogued all of the bacteria that live in and on the human body—over 100 trillion—and began to identify their role in human health and livelihood,” says Leyer. “This database of bacteria is now the foundation for new studies on how dysbiosis may be playing a role in health and disease and some of these new studies are now being published.”

For instance, the gut microbiome may be linked to mental health. States Hazels Mitmesser, “It’s becoming apparent that alterations in the profile of commensal organisms residing in the gut can have an impact on the central nervous system via the gut-brain axis. Animal studies suggest that administration of probiotics can have positive effects on behavior and mood. Preliminary human studies have also begun to explore the potential of probiotics to influence human mood, cognition and fatigue.”

Also in the brain health arena, a separate study found through MRIs that women who regularly ate probiotic-containing yogurt exhibited some changes in the brain regions that control central processing of emotion and sensation (1).

It’s not just the brain that may benefit from probiotics. Levy says a specific strain of B. infantis had immnoregulating effects and may guard against inflammation outside the gut (2). This could be useful for inflammation-related conditions like psoriasis. Says Levy, “This study is important because it is one of the first to show a single probiotic can influence not only the mucosal immune system but also the systemic immune system in humans.”

And, as previously mentioned, the BLIS K12 strain of S. salivarius supports throat health, ear health and fresh breath. “It’s important for both retailers and consumers to remember that specific strains are related to specific benefits and are not created equal,” says Beckman.

The take-home message: care for your digestive system with probiotics and good things will follow for the whole body.

Feed Me!
You’ve undoubtedly heard that prebiotics are food for probiotics, but there’s much more to know.

States Bruno, “Since the use of probiotics plays a role in healthy digestion, it makes sense to support the health of these microorganisms with a prebiotic food source.” These fibrous compounds can be found in foods such as asparagus, burdock, chicory, dandelion root, Jerusalem artichoke, leeks and onions, as well as in some pre-/probiotic combination supplements.

Just how do prebiotics (non-digestible carbohydrates) provide “food”? “Prebiotics are known to resist digestion in the small intestine and reach the colon where they are fermented by the gut bacteria, thus providing beneficial effects throughout the GI,” says Sugarek MacDonald.

Levine explains, “Prebiotics stimulate the growth and/or activity of healthy bacteria (probiotics) in the digestive system.”

To get their full benefit for digestive care, Krahl says prebiotics and probiotics shouldn’t be taken alone. “Shoppers should look for a product that combines prebiotics and probiotics to create a symbiotic effect,” he states.

Prebiotics may also be linked to some digestion benefits on their own. Levy says prebiotics may provide relief for those that cannot digest lactose and “increase the body’s resistance to bacterial infection, boost immune response, and reduce the risk of intestinal disease, cardiovascular disease, non-insulin dependent diabetes, obesity and osteoporosis.”

Peter Finkle, quality assurance director at Yerba Prima Inc., Ashland, OR, provides a rundown of some of the ways prebiotics help the body, in addition to supporting probiotics. Fructo-oligosaccharides (FOS) and inulin support calcium absorption; psyllium husk promotes regularity, reduces problems with diarrhea or loose stools, supports heart health, helps maintain normal blood sugar levels and helps in weight maintenance; and acacia gum promotes colon health by increasing beneficial short-chain fatty acids and helps maintain healthy blood sugar levels. Many are a good source of fiber.

As for which specific prebiotics to recommend alongside probiotics, Hazels Mitmesser states that we’ll have to stay tuned for more info: “Emerging research suggests that certain prebiotics work best with certain strains of probiotics, but specific relationships are still being elucidated.”

For now, manufacturers are using combinations with a history of safety and efficacy, like Lactobacillus and Bifidobacteria species with a prebiotic like FOS, according to Bruno.

Companies are now marketing some unique methods for their effective delivery. For instance, Lowery talks about a capsule (Pre-Pro Combo) from her company that has a capsule-in-a-capsule design. “The inner capsule contains L. acidophilus probiotic, which is then suspended in a liquid-based prebiotic formula containing FOS,” she explains. This prebiotic suspension has low-water activity, and the inner probiotic area takes longer to fully dissolve, ensuring the bugs reach their target intact.

Manufacturers say that taking prebiotics and probiotics together is more of a convenience than a necessity. Nonetheless, Krahl believes “it does make them have a synbiotic effect when combined.”

Adds Sugarek MacDonald, “Preliminary data does suggest, however, that combinations of pre- and probiotics, also known as synbiotics, can provide a positive impact on gastrointestinal health above and beyond what each individual component can provide.”

Breaking it Down
Why enzymes? Enzymes are the key drivers in making sure the body breaks down food properly for nutrient absorption. But, several factors affect this process, making supplement forms important for daily digestive comfort.

According to Danielle Harrison, manager of scientific and regulatory affairs at National Enzyme Company, Forsyth, MO, genetics is one factor, and she uses the example of lactase. “While approximately 70% of the world’s population is genetically hard-wired to lose the ability to produce this enzyme, the remaining 30% has a genetic mutation that allows the continued production of lactase and the continued consumption of milk and other dairy foods without adverse gastrointestinal consequences,” she explains.

In addition, Harrison suggests certain diseases and medications can all affect the body’s production of digestive enzymes. The latter may surprise some shoppers. “Antacids, H2-blockers and proton pump inhibitors are designed to reduce excessive stomach acid by raising gastric pH. However, the higher pH interferes with protein digestion by pepsin, a protease enzyme produced in the stomach,” she says.

Diet, too, plays a role. “Our pancreas produces a blend of proteases, amylase and lipase based upon our regular dietary pattern. This explains why a meal that is unusually large or drastically different in composition can cause digestive discomfort in a healthy individual,” Harrison states. She cites a recent study comparing the levels of secreted enzymes in those who adopted a vegetarian diet for one month (3). “The researchers reported that the levels of elastase, a pancreatic enzyme necessary for the digestion of meat, were significantly decreased,” she states.

Janet Angel, Ph.D., executive vice president of Nature’s Sources, Niles, IL, adds an interesting point: “Exposure to food additives, colorings, preservatives, and genetically altered food can distort your body’s ability to produce the right enzymes.”

Levine says stress is often overlooked for its effect on enzyme production. “Stress can cause cellular damage, which requires ongoing assistance from enzymes to help rebuild and replace damaged cells to maintain a healthy immune system,” he states. “Over time, this can also affect that body’s natural production of digestive enzymes.”

Which ones? Now that we know the “why” about digestive enzymes, it’s time to move into what to do about it. Sugarek MacDonald says enzyme supplements can be a huge help for supporting healthy digestion, but notes that not all enzymes perform the same function.

For instance, she says those that don’t naturally synthesize lactase (and are lactose intolerant) may benefit from lactase in supplement form as well as protease and lipase. And those with heartburn may no longer secrete hydrochloric acid (HCI) and proteolytic enzymes and could benefit from vegetarian-based HCl plus pepsin supplementation. “It is unclear to what extent betaine HCl reduces gastric pH, but, depending on how much is taken, it may possess sufficient acidity to deactivate pH-sensitive enzymes such as those contained in pancreatin,” states Sugarek MacDonald.

Meanwhile, for gluten-intolerant individuals, Sugarek MacDonald explains that “revolutionary developments have taken place in the science community in the last few years allowing for the development of several enzymes including aspergillopepsin (ASP), dipeptidyl peptidase IV (DPP-IV), and cysteine endoprotease (EP-B2), all of which have shown some promise to help those who are gluten-sensitive or have wheat allergies, but not in those that test positive for celiac.” (See Table 2 for more uses.)

Another issue shoppers may want to learn about is whether to take fruit-sourced versus fungus-/bacterial-grown microbial versus animal-based enzyme supplements. This isn’t necessarily a lifestyle choice. Angel states, “For 99% of us, using [vegetarian] acid-resistant complex enzyme formulas that actually reach the small intestines is best.”

Microbial enzymes tend to function in a wide pH range (2.0–11.0), meaning they will work for most individuals. “These enzymes are often more potent and more effective for preventing acid indigestion, reflux, flatulence or other types of digestive disturbances than their animal-derived cousins,” states Levy.

Harrison states that enzymes extracted from fruits are almost exclusively standardized for proteolytic activity like bromelain, papain and actinidin.

Animal enzymes often work in a narrower pH range, says Angel, “and therefore may or may not work well for everyone at a given time.” Levy explains they can’t function in the stomach.

Harrison points out animal-based enzymes require enteric coatings to protect them from gastric acidity. “These coatings are sometimes unreliable in their dissolution, by either dissolving too quickly, thus destroying the supplement or too slowly, disallowing the opportunity for the enzymes to hydrolyze the foods consumed,” she believes.

However, Angel says there’s definitely a time and a place for animal-derived pancreatic enzymes or even HCl. They may be beneficial for breaking down protein and start their action in the intestines when properly encapsulated.

Levy says individuals may want to choose a comprehensive product that contains protease, lipase and amylase. “All three are needed for optimal digestion; however, there is no ideal one-size-fits-all ratio. Their ratio depends on the individual’s diet,” he explains. “For example, someone who routinely eats lots of carbohydrates and processed foods may need more amylase. Those eating a low-carb or Paleo diet, on the other hand, may need more protease and lipase.” You’ll definitely want to explain this to first-time enzymes shoppers.

What does the label mean? The label on a supplemental enzyme is something ripe for consumer education. “Product supplement facts labels can be very confusing to the consumer,” Hazels Mitmesser says. “Often, enzymes are listed by activity levels; however, you may also see the actual weights of the added enzymes listed.”

In general, Hazels Mitmesser says, “the higher the activity level, the higher the product efficacy, but this is certainly not always the case.” Some supplements may include less of a certain enzyme by weight, but it may be just as effective. “It all comes down to the listed activity levels,” Hazels Mitmesser states.

She explains that activity levels measure the ability of enzymes to catalyze in certain conditions. Assay units are expressed in a variety of ways, such as PC, HUT, FCC, FIP, ALU and more. These standards come from various sources like the Food Chemicals Codex (FCC, which recognizes DU, ALU, HUT and others) and the U.S. Pharmacopeia. “It is very important to make sure you compare activity units from the same compendium, as some are not as well regarded,” says Hazels Mitmesser. “In essence, you may be comparing apples to oranges with certain enzymes. Some manufacturers may use the higher of the two activity values, because they believe the consumer will believe the product to be more efficacious when this may not be true.” WF

References
1. K. Tillisch, et al., “Consumption of Fermented Milk Product with Probiotic Modulates Brain Activity,” Gastroenterol. 144, 1394–1401 (2013).
2. D. Groeger, et al., “Bifidobacterium infantis 35624 Modulates Host Inflammatory Processes Beyond the Gut,” Gut Microbes 4 (4), 325–339 (2013).
3. J. Walkowiak, et al., “Adaptive Changes of Pancreatic Protease Secretion to a Short-Term Vegan Diet: Influence of Reduced Intake and Modification of Protein,” Br. J. Nutr. 107 (2), 272–276 (2012).

Published in WholeFoods Magazine, April 2014