Probiotic Waters: The Undiluted Truth - Dr. Michael Ruscio, DC

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Probiotic Waters: The Undiluted Truth

Should You Get on Board with the Trend for Probiotic Enhanced Beverages?

Key Takeaways:

  • Probiotic waters and other beverages that contain probiotic cultures are the new hydration/gut healthcare trend. 
  • Probiotic waters can have benefits similar to traditional probiotic supplements, but often don’t contain multiple species of bacteria, which offer more health benefits.
  • Probiotic waters also contain a lesser amount of bacteria than most capsule formulations. So if you’re looking for a therapeutic benefit, traditional probiotics are better here too.
  • Most contain sweeteners and flavors and are distinct from dairy products like kefir and probiotic yogurt drinks.
  • The long-term viability of probiotics in water is also not clear; it’s likely that probiotics that are freshly added to water are best.
  • Overall, traditional probiotic supplements, like capsules and powders, are better researched and tend to be higher dosage and better value.

If you’re interested in supplementing with probiotics for gut health you may have noticed a big increase in the number of probiotic waters and other probiotic drinks on the market. In 2020, probiotics for digestive health claims accounted for over a third of the new functional beverage launches in North America, so it looks like a trend that’s here to stay [1].

But do flavored waters laced with added probiotics offer the same benefits as other more traditional forms of probiotics? The short answer is “no” but there may be reasons to prefer one form over another depending on your preference. In this article, we will look at the pros and cons of probiotic waters, and help you decide which might be right for you. 

What Is Probiotic Water?

Probiotic water is a new type of commercial supplement beverage consisting of probiotics dispersed in spring water, often with sweeteners like stevia and other nutrients such as electrolytes and essential vitamins (e.g. vitamin A, vitamin E, vitamin B12, and chromium). They can be plain or come with added natural flavors in varieties such as berry cherry or strawberry lemonade. In short, many probiotic waters are a cross between vitamin water and probiotic supplements. 

Probiotic waters are distinct from dairy-based probiotic drinks and different from probiotic capsules, which tend to be higher potency. They also differ from fermented foods and drinks, e.g. kombucha, yogurt, kefir, and apple cider vinegar, which have variable benefits and probiotic content dependent on the starter culture and any subsequent processing.

Before we go into more detail on probiotic waters, here’s a quick run through the pros and cons of all the main probiotic sources.

Different types of Probiotics: Pros and Cons

Probiotic watersTasty, no swallowing of capsules is involved. The popular products in the US contain an effective soil-based probiotic. Vegan friendly.Rarely multi-strain, very expensive, and not particularly high potency. May contain additives and sweeteners. Probiotics may degrade in water over time.
Dairy probiotic drinksHave some good research backing. The alkaline effect of dairy in the stomach can increase viability.Some people can’t tolerate dairy proteins or lactose. Tend to contain quite high sugar levels. Need refrigeration.
Traditional capsules and powdersThe form of probiotic used in most research. Properly formulated, capsules and powders have high viability and some don’t need refrigeration. Available in high potencies.May not work for you if you have trouble swallowing capsules. Some strains and brands require refrigeration.
Probiotic (fermented) foodsHealthy, usually only lightly processed foods that are useful alongside probiotic supplementation. Offer general gut health maintenance benefits.Don’t deliver a high enough dose of probiotics on their own for most health issues.

What Do Popular Probiotic Water Products Contain?

Some of the biggest brands of probiotic water are:

  • Karma Probiotic Water® 
  • The Bu™ Sparkling Probiotic Water 
  • KAMSA™ Probiotic Water
  • Symprove™ 

Of the above, only Symprove™, which is a UK brand, has had its health benefits directly evaluated in peer-reviewed studies. Symprove™ contains an extract of germinated barley mixed in water with the probiotics Lactobacillus rhamnosus, Enterococcus faecium, Lactobacillus acidophilus, and Lactobacillus plantarum.

It contains 10 billion colony-forming units (CFUs), which places it at the top of the list when compared to other probiotic waters. In the three main studies of Symprove™ in humans (randomized controlled trials), the product was noted to:

  • Lessen the severity of IBS symptoms [2].
  • Reduce the frequency of constipation, diarrhea, and back (but not abdominal) pain in people with diverticular disease [3].
  • Reduce intestinal inflammation in patients with ulcerative colitis (but not in patients with Crohn’s disease) [4].

Karma Probiotic Water®, which is the most popular US brand, hasn’t been studied directly. However its active ingredient, the soil probiotic strain Bacillus coagulans GBI-30 (GanedenBC30®), has been the subject of several clinical trials. Each bottle contains 2 billion CFU.

Some of the reported benefits of Bacillus coagulans ( GanedenBC30®) include:

  • Immune system / immune support benefits: In a randomized clinical trial, healthy young children who took Bacillus coagulans daily for three months had decreased incidence of upper respiratory symptoms. When nasal congestion, bloody nasal mucus, itchy nose, and hoarseness occurred these symptoms didn’t last as long [5].
  • Senior benefits: When taking Bacillus coagulans, older participants had significantly higher populations of good bacteria in the digestive tract and higher levels of the anti-inflammatory chemical cytokine, IL-10 [6].
  • Recovery benefits: Compared with those who took casein (protein powder)  alone, casein plus Bacillus coagulans resulted in significantly better recovery and less soreness in a group of male athletes [7]. 

The probiotics in Karma are in a powdered form inside the specially designed push cap (‘Karmacap”) [8], which is separate from the drink itself. When you’re ready to drink the probiotic beverage, you push the dry powdered probiotics for mixing.

The Bu Sparkling Probiotic Water  and KAMSA Probiotic Water also contain Bacillus coagulans, but in this case, the friendly bacterium is added to the water at manufacture. The quoted potency (2 billion in both cases) is at the time of manufacture, not the guaranteed level when you consume it. 

Probiotic Drinks Versus Probiotic Supplements

When it comes to comparing the efficacy of probiotic waters and drinks with more traditional capsules and powders it might seem there isn’t enough evidence to draw firm conclusions. But dig a little deeper and supplements have the advantage. 

Liquid probiotics that contain prebiotics or proteins seem to work well as these ingredients may help keep the bacteria alive and protect them from digestion. They may even have the edge over freeze-dried powdered supplements according to one study [9].

However, probiotic waters that don’t have these ingredients, or which aren’t properly refrigerated, or are too acidic, might not deliver probiotic benefits at all well. Probiotics added to commercial drinks at manufacture (not just before you drink) may also lose potency. 

To these observations, we can also add the results of two reviews that support traditional supplements (in dried form) over liquid forms.

  • The first review, from 2014, found probiotic capsules or tablets to be the most effective probiotic delivery system [10]. 
  • The second, from 2018, reported that probiotics from enteric-coated capsules and freeze-dried capsules may be superior for delivering an effective dose of bacteria when compared to probiotic fermented milk (PFM) drinks [11].

When you factor in other important factors — cost effectiveness, potency, and bacterial diversity — powders and capsules start to look more attractive compared with probiotic waters and drinks.

Multistrain Probiotics Offer More Health and Cost Effectiveness

The three most popular probiotic waters in the USA — Karma Probiotic Water, the Bu Sparkling Probiotic Water, and KAMSA Probiotic Water — all only contain one species of bacteria. However, in conditions like IBS, there’s strong evidence that multispecies probiotics are more effective than single species of probiotics [12, 13, 14]. 

Through my clinical practice, I can also confirm that the best results come from patients who combine probiotics together, more specifically lacto-bifido bacteria, friendly yeasts, and soil microorganisms.

Probiotic Waters: The Undiluted Truth - Probiotics%20Strains%2C%20Species%2C%20and%20Categories 16x9 Landscape L

Potency (measured as colony-forming units) and cost-effectiveness also matter too, and probiotic supplements win hands down here too. 

For example, the following table compares the cost of probiotics I recommend to my patients, versus Karma Probiotic Water®:

ProductTotal # Servings per packageCFU/servingTotal cost per package (in US dollars)Cost/servingCost/2 billion CFUs (the amount in one Karma Probiotic Water)
FMF Triple Therapy Probiotic Powder Sticks3062 billion$99.95$3.33$0.11
FMF Soil-Based Probiotic604 billion$43.95$0.73$0.37
FMF Lacto-Bifido Blend3050 billion$49.95$1.67$0.07
FMF S. boulardii306 billion$37.95$1.27$0.42
Karma Probiotic Water12 billion$2.00$2.00$2.00
Symprove (only available in the UK)2810 billion$61.27 (£49.99)$2.19$0.44

As you can see, probiotic supplements are much more cost-effective. To look at it another way, it would take 31 18  fl oz bottles of Karma Probiotic Waters ($63.00) to get the same amount of probiotics in one Triple Therapy Probiotic Powder Stick ($3.33), and you wouldn’t even be getting the same diversity of bacteria. 

Additionally, 2 billion CFU (the amount in most US-based probiotic drinks) is not a therapeutic dose for most health conditions.

Are Liquid Probiotics More Viable?

In theory, probiotics dissolved in water shouldn’t be any better or worse in terms of absorption and viability than a probiotic capsule swallowed with a glass of water. 

However, while there’s not much research on the topic, the studies that do exist suggest that probiotics in water can be more sensitive to things like temperature and acidity. For example, it’s been found that: 

  • Probiotics can stay stable in 39.2℉ water for up to 6 hours, but they can become unstable and less potent over time [15].
  • Higher temperatures, including room temperature, will degrade the probiotics in water faster [15].
  • The pH of the water you put probiotics into can affect how well the probiotics survive. For example, adding acidic fruit juice to the water your probiotics are in can reduce the pH enough to kill the live active cultures [16, 17]. Fructose added to probiotic waters may also lessen probiotic survivability [18]. 

You also have to consider that probiotics ‘waters’ may also contain additives and sweeteners you might not want to consume when you are eating clean. 

Another argument used by makers of water-based probiotic drinks, particularly Symprove™, is that the probiotics in a drink survive the acidic environment of your stomach better. They say that liquids don’t trigger digestion like solid food would (though you do have to take in an empty stomach for this to be the case).

A study sponsored by Symprove™ did indeed show that the bacteria in the product survived stomach acid intact, but the researchers commented that the high survivability is likely from the germinated barley extract in the product (a prebiotic that can keep bacteria alive) rather than anything to do with it being water-based or not stimulating digestion [9].  

Dairy-based probiotic drinks, if you can tolerate them, also have high survivability in the gastric juice of pigs (which is similar to ours) according to research. But it’s more likely the milk proteins that protect the probiotics from being degraded by stomach acid, rather than the fact that they are fluid based [9]. Let’s take a deeper look at these probiotic drinks. 

Dairy Probiotic Drinks

Other popular probiotic drinks include dairy-based products such as kefir and yogurt drink brands including DanActive and Yakult.

There’s some decent evidence for these dairy probiotic drinks, which I’ve already outlined in more detail in a previous blog post about probiotic drinks. However, in a nutshell, fermented dairy products may improve the balance of gut bacteria [19, 20] and have some benefits for conditions such as respiratory infections, Crohn’s disease, high cholesterol levels, and Clostridium difficile associated diarrhea [21, 22, 23, 24]. 

However, a good multi-species probiotic taken in supplement form will deliver at least this many benefits, but without dairy, which many people with gut problems can be sensitive to. Dairy probiotic drinks can also often contain a lot of sugar, which is known to cause health issues when consumed regularly.

What About Kombucha?

Kombucha is a probiotic drink made with fermented tea which can also also be classified as water-based (it’s dairy-free).

Though kombucha is purported to have anti-inflammatory and antioxidant properties there is a lack of research to support its use for specific health problems [25].

One 2019 systematic review attempted to find human studies describing the health benefits of kombucha but found only one low-quality study. In this study, daily consumption of 60 ml (two tablespoons) of kombucha for 90 days was associated with improved blood sugar levels in 24 subjects with type 2 diabetes.

Apple cider vinegar is an alternative to kombucha that does have some documented health benefits. However, the gut benefits that people experience from apple cider vinegar are likely from promoting a healthy gut environment that allows good bacteria to flourish, rather than providing probiotics directly.

Food as a Probiotic Source

Probiotic Waters: The Undiluted Truth - Probiotic%20Foods 01 L

Some fermented foods, such as natural yogurt, kimchi, and sauerkraut are good natural sources of probiotics. But you’d have to eat a lot of them to have the same effect as a specifically designed probiotic supplement, whether that be a capsule, powder, or probiotic drink.  

One 2017 literature review found the dosage of probiotics in food products (in the Canadian food supply) was too low to provide the benefits of probiotic supplements seen in clinical trials [26].

If they fit with your food preferences and don’t trigger any gut sensitivities, I recommend eating probiotic foods as a useful part of a gut healing or gut maintenance diet.  However, targeted probiotics are better by far if you need more substantial health benefits.

Probiotics Waters Are Not a Perfect Solution

I’m happy with anyone trying to get more gut-healthy probiotics in their diet whether that be from food, drinks, or powder/capsule supplements. But some probiotic waters could be less effective and more expensive than probiotic supplements. They also tend to offer fewer strains and can have additives and sweeteners you might not want to have in your diet.

I have seen the best results with patients who combine lacto-bifido bacteria, friendly yeasts, and soil microorganisms together, either taken as capsules or powder that you can stir into water or sprinkle over food. 

If you have tried probiotics and dietary improvements but still need help with gut-related issues you can contact us at the Ruscio Institute for Functional Medicine for a more thorough evaluation of your health with an experienced qualified practitioner.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
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