August 2014 Issue

Dairy’s Probiotic Power — A Review of the Benefits of Probiotics, the Top Sources, and What’s New in the Dairy Case
By Juliann Schaeffer
Today’s Dietitian
Vol. 16 No. 8 P. 32

At any given time, hundreds of species of bacteria—both potentially harmful and potentially helpful—inhabit the human digestive tract. Probiotics are the “friendly” types that help to ferment, decompose, and digest the foods we consume.

Thus far, research has suggested that there’s potential in how certain probiotic strains may help aid certain ailments. “Research has shown that certain strains of bacteria may help promote good digestion (eg, lactobacillus and bifidobacterium), boost the immune system (eg, Bifidobacterium bifidum and Streptococcus thermophilus prevented rotavirus infection), and fight infections (eg, Lactobacillus GG to treat Clostridium difficile),” says Sherry Coleman Collins, MS, RDN, LD, owner of Southern Fried Nutrition Services in suburban Atlanta.

What’s more, research is examining probiotics’ potential effects on digestive disorders such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) as well as how a certain strain of the beneficial bugs even may help lower cholesterol. “Probiotics have a very good safety record and have been successfully used with patients suffering from a variety of illnesses and compromised immune systems,” Collins says, adding that she still recommends that all clients who are interested in starting a regular probiotics regimen to treat disease first consult their physician.

Though Collins notes that the current evidence may support probiotic consumption for many different health benefits, she cautions that the research has yet to confirm these findings “since there aren’t studies looking at ‘deficiencies’ among those who don’t consume probiotics,” she says.

Joanne Slavin, PhD, RD, a professor at the University of Minnesota and a nutrition researcher, agrees: “We don’t have great intake data on probiotics, so it’s difficult to show relationships between intake of probiotics and health outcomes.” Since there are no universally accepted methods to measure probiotic intake, she says this also makes it difficult to rank or compare products.

Nevertheless, it’s well known that dairy is one of the main healthful sources of probiotics, with yogurt being the most popular among consumers. And if probiotic curiosity leads more people to include yogurt in their diet, Slavin says that isn’t bad. Here, dietitians discuss dairy’s probiotic prowess, which products are the best sources, and what’s new in the dairy case.

Dairy’s Benefits
Dairy is one of the most regularly accessible and acceptable food categories that contain probiotics, Collins says. That, with its overall nutrient profile, makes it a great form in which to consume probiotics. “When working with clients, I always try to encourage them to choose foods that are nutritionally dense, and dairy is one of those foods,” she says.

“In addition, there’s some evidence that foods that provide probiotics and prebiotics [nondigestible parts of foods that become fuel for probiotics] may enhance mineral absorption,” she adds. “Therefore, eating yogurt and other probiotic dairy foods may help ensure that calcium and other minerals in dairy yogurt are absorbed.”

Yogurt also is a great vehicle for getting probiotics, Collins says, because of the nutrient profile of cow’s milk. And for people, particularly kids, who don’t like milk, yogurt provides another way to get the vitamins and minerals in cow’s milk into their system. “While many things [such as sauerkraut, miso, and tempeh] can be fermented to produce healthful live active cultures, cow’s milk packs a powerful vitamin and mineral profile along with the gut-restoring probiotics,” says Christa Byrd, MA, RD, a clinical dietitian at Beaumont Health System in Royal Oak, Michigan. “[But] yogurt is better tolerated by people who are lactose intolerant because the bacteria digest the lactose or milk sugar while fermenting the milk, which produces increased lactic acid and decreased lactose.” According to Slavin, yogurt is particularly beneficial for children who don’t like the taste of cow’s milk because yogurt provides high-quality protein, vitamin D, and calcium.

According to Kristin Kirkpatrick, MS, RD, LD, manager of wellness nutrition services at the Cleveland Clinic, yogurt’s accessibility and familiarity make it a great starting point for most people looking for probiotics, and many varieties offer a big probiotic punch. “Yogurt and kefir will have the most probiotics,” she says.

Because heat kills the bacteria in yogurt, Kirkpatrick recommends researching whether a particular brand has been heated after production or just look for the “live and active cultures” seal to ensure there’s enough probiotics to provide any potential benefit. “Yogurt and most probiotic-containing drinks aren’t heated before serving, so they’ll be the most reliable sources,” she says.

What’s New on Store Shelves
As the media spotlight continues to shine its healthy halo on the probiotic buzzword, food companies continue to offer consumers new ways to get their daily dose of the beneficial bugs. New yogurt flavors, single-shot probiotic drinks, and frozen kefir bars are just a few of the new forms probiotics are taking at the grocery store today. Dietitians speak out on the latest probiotic dairy trends as well as provide tips on how to recommend clients incorporate these bugs into their daily meals.

“Because yogurt is available in every supermarket and many convenience stores and even fast-food restaurants, Americans have easy access to probiotics via this favorite food,” Collins says.

By far, yogurt also offers the most flavor and texture options. Even so, she says it’s important to consider quality when surveying for probiotic content. “While yogurt may be available almost everywhere, the practitioner should know that good-quality yogurt with multiple strains of bacteria and live, active cultures must be eaten to get the best benefit,” Collins says. “Bacteria in foods is sensitive to time and temperature, so if it’s improperly stored, the bacteria may not be alive or in adequate amounts to be of benefit.”

Yes, yogurt generally has the greatest amount of probiotic content, says Janet Colson, PhD, RD, a professor of nutrition and food science at Middle Tennessee State University in Murfreesboro, but bacteria strains and numbers will vary by brand, so she recommends clients know their yogurt before purchasing. “The ingredient label indicates the strain but not the number of bacteria,” she notes.

In general, Colson says the number of live bacteria likely will decrease as the yogurt sits in the refrigerator, so fresh is best. “In some cases, the bacterial content increases [as yogurt sits], which depends on the strain of bacteria,” she says, noting that this isn’t the case for the majority of probiotic-containing yogurts. The bacteria Lactobacillus rhamnosus (found mainly in Stonyfield yogurt varieties) tends to be more stable during storage than other bacteria.

Colson says the leading yogurt trend she’s seen lately is the increased types of bacteria that food companies are offering in yogurt varieties as well as additional flavor options. “Lactobacillus bulgaricus and Streptococcus thermophilus are the only two cultures required by law to be present in yogurt. However, many yogurts have more than these two,” she says.

Greek yogurt continues to increase in popularity, so it’s no surprise that many of the latest product innovations are coming from Greek (or similar) varieties. According to Byrd, Greek yogurt is her go-to patient recommendation, particularly for wound healing. “When dealing with underweight patients in the clinical setting who have increased protein needs for wound healing, yogurt is my No. 1 supplement recommendation, especially Greek yogurt, which packs a powerful 13 g of protein per 100-kcal serving,” she says.

“Yogurt is a great option because pressure sores and unintended weight loss are commonly seen in the elderly, who also are more likely to be lactose intolerant,” she adds. “The low-lactose profile of yogurt makes it helpful and easy to digest. Yogurt also is a low-cost supplement, which is easy to find in a variety of flavors that patients can easily continue [to consume] at home.”

In addition to the starter cultures, Stonyfield products contain three other probiotic cultures: Lactobacillus acidophilus, Bifidus, and Lactobacillus casei. Stonyfield, which recently introduced a creamier texture to its line of organic Greek yogurt, now offers two new flavors: Black Cherry and Café Latte. Cobranded with Happy Family, Stonyfield also recently launched yogurt pouches for the younger set under the preexisting brand names YoBaby, YoTots, and YoKids, all of which contain the same probiotic strains as its other yogurt products.

YoBaby pouches offer whole-milk yogurt in four varieties, including Blueberry and Mango, with fish oil–sourced DHA and EPA omega-3 fatty acids. YoTots offers a similar yogurt formulation with slightly more adventurous veggie-fruit options, such as Pear Spinach Mango, meant to introduce toddlers to new flavors. And YoKids pouches feature low-fat yogurt in Blueberry, Strawberry, and Strawberry Banana flavors.

Three Happy Cows, another Greek yogurt company that uses a blend of probiotic strains, recently launched Strawberry, Blueberry, Caramel, and Vanilla Bean flavors, with 11 to 12 g of sugar and 15 g of protein in each serving.

Greek yogurt manufacturer Chobani, which includes three strains of probiotics in all of its products, introduced a range of new options this summer. In addition to a dessertlike full-fat line called Chobani Indulgent, the company is offering a new line called Chobani Greek Yogurt Oats, made with real fruit and whole grain steel-cut oats for added fiber.

For weight-conscious consumers, Chobani Simply 100 Greek Yogurt offers 100-kcal varieties in Key Lime and Pineapple Coconut, and Chobani Kids offers kids a low-fat, low-sugar Greek yogurt line with flavors such as Grape and Watermelon. Chobani’s Seasonal line, with Watermelon and Pink Grapefruit highlighting the summer’s freshest flavors, also is new, as is its 4% whole milk Chobani Kitchen, which is touted as perfect for baking.

A relative newcomer to the yogurt section, Noosa Yoghurt describes itself as an Aussie-style yogurt that’s plenty thick and paired with fresh fruit purées and honey in addition to a blend of probiotics. Its yogurts contain a blend of five cultures (the same strains Stonyfield products offer) and new flavors include Pineapple and Coconut as well as a Plain variety.

For clients who can’t (or choose not to) eat dairy, Kirkpatrick says there are soy- and coconut-based yogurts that also provide probiotics. Byrd likes Trader Joe’s Coconut Yogurt for people with a milk protein allergy. “It’s a good fermented snack with active cultures, although it contains a little less protein than other yogurts,” she says.

With so many new brands and product lines filling the yogurt case, where should clients look for the most benefit? According to Colson, the most important thing is to guide clients toward live, active cultures first and low sugar next. “I personally only select plain fat-free yogurt and use it in place of sour cream on vegetables or a casserole and for whipped topping on fruits,” she says.

Research has yet to determine which probiotic strains can elicit specific benefits, but Colson says when it comes to looking at ingredient labels, the more bacteria strains a yogurt contains, the better. (Both Stonyfield and Noosa yogurts contain five strains, whereas many varieties offer two to three.)

“I would avoid selecting a yogurt that has too many added sugars, candy, or cookies—basically, the dessert type,” she adds. “People can easily gain an excessive amount of weight by eating yogurt for the health benefits and end up having so much added sugar and fat that the detriments outweigh any possible health benefits.”

It’s also easy for clients to spend more cash than they intended when looking for new yogurt options, but Kirkpatrick says a steady eye can solve that problem. She tells clients to “read the ingredients. Buying an off-brand yogurt containing the same species of probiotics as the name brand will still provide the same benefit.” She also notes that yogurt can be the most cost-effective way to get their daily probiotics, if consumers shop carefully.

Collins agrees: “There are some store brands that are as robust in the strains of bacteria as the more expensive name brands. Looking for sales and coupons is always a good tip for saving bucks at the grocery store.”

Probiotic Dairy Drinks
While not as widely known or loved as yogurt, the yogurtlike probiotic drink kefir is gaining in popularity. Collins says kefir is available in most supermarkets and specialty nutrition stores, and with far more strains of bacteria than yogurt, she says kefir is a delicious drinkable dose of probiotics. “Kefir typically contains 10 different strains of bacteria,” she says.

Lifeway, which makes a range of kefir products that all offer its blend of 12 probiotic cultures, has introduced a few ways for people to enjoy its probiotic drinks. Veggie Kefir is a savory alternative to fruit-flavored kefirs. A new blend of vegetable juices and kefir, it delivers one full serving of vegetables as well as the full nutritional kick of kefir per 8-oz glass. It comes in Tomato, Cucumber, and Beet varieties.

Lifeway’s Kefir With Oats provides consumers with 1.5 g of soluble oat powder mixed with kefir. With a smooth texture and a hint of oat flavor, Kefir With Oats offers 11 g of complete protein in breakfast-friendly flavors such as Blueberry Maple, Cinnamon Apple, and Vanilla Plum. For clients watching their sugar intake, Lifeway offers Perfect 12 Kefir, which is sweetened with stevia and has no added sugar and only 12 g of carbs.

In addition to kefirs, there are drinkable yogurts available that offer probiotics as well. California-based GlenOaks Farms, which debuted the first drinkable yogurt in the 1980s, recently introduced GlenOaks Drinkable GREEK STYLE Yogurt, offering more protein in addition to its live and active cultures in Peach, Raspberry, and Strawberry flavors.

Collins also has seen a trend in drinkable yogurt products specifically designed to be probiotic “shots” that pack lots of probiotics into small quantities. One such option is Bio-K+, a liquid probiotic that uses dairy, soy, and rice to make its formula of 50 billion bacteria, which it packs into a single-serving shot of sorts. The bottle is more akin to the size of a small yogurt container and can be consumed in one serving. Or individuals can consume one-quarter to one-half of the drink at a time and still reap the probiotic benefits.

Cheeses and Spreads
Even though all cheese (except processed) is fermented, Byrd says, that doesn’t mean all varieties contain probiotics, and those that do may not survive conditions in the gastrointestinal tract. Because of this, she says it’s just as important for clients to check the labels for live and active cultures on any product they believe has probiotic cultures.

A relatively new player in the probiotic category, and a potentially new way to entice clients to consume probiotics, are yogurt and cream cheese spreads. Sonya Angelone, MS, RDN, CLT, a spokesperson for the Academy of Nutrition and Dietetics, likes the cream cheese and yogurt spread from Green Mountain Farms, which comes in individual 1-oz containers for convenience. “Although a bit more expensive than buying one large container and portioning out a serving, it may make the difference between eating it and not eating it,” she says.

Angelone likes suggesting clients try the spread on bagels, wraps, sandwiches, celery sticks, and even in smoothies. Whereas regular cream cheese provides about 10 g of fat and 1 g of protein with 100 kcal/oz (with no probiotics), Green Mountain spread has “4 g of protein, 3.5 g of fat, and 60 kcal/oz with live and active cultures,” she says.

For fruit aficionados, discount retailer Aldi recently rolled out a Greek yogurt fruit dip that blends Greek yogurt and cream cheese and contains live and active cultures. In two flavors, Strawberry and Vanilla Bean, each serving provides 4 g of fat, 2 g of protein, and 70 kcal.

Karoun Dairies also introduced its healthier alternative to cream cheese called Blue Isle Mediterranean Yogurt Spreads. Similar in consistency to cream cheese, the spreads contain 6 g of fat, 1 g of protein, and 60 to 70 kcal in addition to its probiotic blend. Blue Isle spreads come in five varieties: Blueberry, French Onion, Honey, Original, and Spicy Vegetable.

Karoun Dairies also offers a line of flavored soft yogurt cheeses called Karoun Labne. This line of Mediterranean-style spreadable cheese also contains live and active cultures and comes in Creamy Ranch, French Onion, and Spicy Garden Vegetables.

Frozen Offerings
The frozen foods aisle also contains probiotic-containing dairy products. “Frozen Greek yogurt has become very popular, and frozen kefir is now available,” Kirkpatrick says. Various companies, including Lifeway, are offering frozen kefir bars/ice creams, but Kirkpatrick cautions clients and patients who may want to consume such tasty-sounding products as the main source of their probiotics.

While noting that frozen products still can have the live and active cultures seal if they contain enough viable bacteria per gram at the time of production, she urges clients to see such ice cream–like options for what they are: dessert. “I wouldn’t recommend these as a main source of probiotics. They’re desserts and should be consumed in moderation,” she says.

Counseling Takeaway
Whether clients seek to get their probiotics from a single-serving shot, a spoonable yogurt, or even a spread on their morning bagel, Byrd says her advice to clients is similar: Look to include fermented foods in your diet three times per week, and avoid added sugars whenever possible. “Use caution with products containing increased sugar, as this may not only add empty calories, but it may negate some of the healthful gastrointestinal benefits,” she says. “Excessive sugar intake also can disrupt the balance of healthful bacteria that works to breakdown and digest the foods we eat by increasing the gas-producing [bloating] fungal inhabitants.”

In general, Collins recommends most clients consume 6 to 8 oz of plain yogurt or 4 oz of kefir per day to maintain good digestion, upping that recommendation to twice per day if a client seeks to prevent antibiotic-induced diarrhea, for example.

“I recommend my clients choose a yogurt with the most different strains of bacteria—five or more—since different bacteria seem to have different positive health benefits,” she says. “Buying the freshest yogurt available helps ensure live and active cultures, and avoid those with added stabilizers and gelatin, since quality yogurt doesn’t need those added ingredients to be thick and creamy.”

— Juliann Schaeffer is a freelance writer and editor based in Alburtis, Pennsylvania, and a frequent contributor to Today’s Dietitian.