Review: In Search of a Probiotic Yogurt: Gems Amongst the Supermarket Brands?

Milk Aisle
Can good probiotics be found in the dairy aisle near you?
Ever wondered if regular yogurt is just as useful as a probiotic supplement? Or have you wondered if the claims behind special probiotic yogurt brands are true? Read on. The purpose of this article is to give you a better handle on the beneficial bacteria strains found in different yogurt brands along with scientific evidence describing their possible benefits.

If you like yogurt, you’re not alone. Yogurt has become big business in the US with a projected 7 billion market1. Forbes magazine has even noted that a “Yogurt War” has started with even more companies trying to get involved2, including the soda-giant Pepsi1. The reason behind this rise in popularity is, in part, due to the marketing of Greek-style yogurts, now 40% of the total market1. However, even more importantly, there is scientific evidence showing that the bacteria found in yogurt are really good for you. Probiotic yogurt might have real health benefits.

Probiotics?

Probiotics are microorganisms that are known to confer a benefit on the host. In other words, probiotics are any kind of small living creature (whether it be a bacterium, fungus or parasite) that makes you healthier. In the case of yogurt, we are strictly speaking about bacterial probiotics. Science is proving that, in general, most bacteria used in yogurt production have probiotic characteristics. However, not all bacteria are alike and neither are the bacteria strains used in commercial yogurts. Some bacteria strains may be more healthful than others.

Yogurt Brands and Bacterial Species

According to the Dairy Reporter, the top four brands in the United States include: Yoplait, Chobani, Stonyfield and Dannon3. All of these brands can be found at a regular supermarket. Interestingly, of these four brands, only Dannon has products that are specifically marketed as probiotic yogurt with special strains. Other brands that are also popular, but may be harder to find, include Fage Total Greek Yogurt, Greek Gods Yogurt, La Yogurt and Voskos Greek Yogurt. The list below provides information about the species/strains used to produce each product.

Yogurt BrandsBacteria Strains
YoplaitLactobacillus bulgaricus
Streptococcus thermophilus

sometimes: Lactobacillus acidophilus
ChobaniLactobacillus acidophilus
Bifidobacterium bifidum
Lactobacillus casei
Stonyfield FarmsLactobacillus bulgaricus
Streptococcus thermophilus
Lactobacillus acidophilus
Bifidobacterium bifidum

sometimes Lactobacillus rhamnosus
DannonLactobacillus bulgaricus
Streptococcus thermophilus

sometimes: Lactobacillus acidophilus
Bifidobacterium lactis
DN-173 010 in Activia
Lactobacillus casei DN-114- 001 in DanActive
YakultLactobacillus casei Shirota
FageLactobacillus bulgaricus
Streptococcus thermophilus
Lactobacillus acidophilus
Bifidobacterium bifidum
Lactobacillus casei
Greek Gods YogurtLactobacillus bulgaricus
Streptococcus thermophilus
Lactobacillus acidophilus
Bifidobacterium bifidum
Lactobacillus casei
La YogurtLactobacillus bulgaricus
Streptococcus thermophilus
Lactobacillus acidophilus
Bifidobacterium bifidum
Lactobacillus casei
Bifidobacterium animalis BB12
Voskos Greek YogurtLactobacillus bulgaricus
Streptococcus thermophilus
Lactobacillus acidophilus
Bifidobacterium bifidum
Lactobacillus casei


Finding probiotic yogurt

Unfortunately, most studies looking at probiotic benefits are designed using a mixture of different bacteria. This makes trying to determine the individual benefits of each strain very difficult. Furthermore, it is possible that the effects of an individual strain are altered when included within a mixture. Therefore, it’s not always a simple situation of “1 + 1 = 2.”

Benefits of the Basic Starters

The most widely used general yogurt culture species are Lactobacillus bulgarus and Streptococcus thermophilus. Additional strains are added for taste, texture or for probiotic benefits. There are several studies that have studied these classical yogurt bacteria on their own. Both of these species are known to survive the gastrointestinal tract4, 5. It is also confirmed that after consumption of these two bacteria, changes can be found in the fecal microbiota6. There are few clinical studies performed with these two species. In a study with non-alcoholic fatty liver disease patients, it was found that they could improve liver enzyme levels7. Additionally, they also boosted the immune system in anorexia patients8 and helped lactose absorption in lactose-intolerant patients9. There are also some studies that suggest replacing baby formula with regular yogurt can help with bouts of infant diarrhea10, 11.

Beyond Simple Yogurt Species

Besides the basic starter strains mentioned previously, Yoplait yogurt only adds L. acidophilus to its mix. This trio is not well investigated in humans and nor are the combinations used in Chobani, Stonyfield Farms, Fage, Greek Gods Yogurt and Voskos Greek Yogurt. The reason is that most researchers prefer to look at more complex mixes with additional species and unique strains that have more exciting effects.

It is important, in this regard, to remember the difference between species and strains. A species is a unique life form: like humans, dogs or cats. Reproduction between species is, in general, not possible. A strain, on the other hand, is like a breed or race. For instance, dogs are classified into breeds. While they can easily produce young through crossbreeding, each breed does have its own unique character. For bacteria, it’s the same, and this is why the majority of probiotics studies need to be examined carefully. You can’t assume that the species tested are the same strains, and this makes comparisons extremely difficult. The only brands of yogurt that have scientifically studied strains are La Yogurt; Dannon’s Activia and DanActive; and Yakult.

Bifidobacterium animalis lactis BB-12 – La Yogurt

While the precise bacteria combination found in La Yogurt hasn’t been scientifically evaluated, there has been a lot of research done on the strain, Bifidobacterium animalis lactis BB-12, which it contains. This strain, in combination with other bacteria, has been used multiple times in clinical trials. However, studies looking at it on its own are more limited.

That B. animalis lactis BB-12 can affect the immune system is quite clear12-14. In general, it appears to lower inflammation. However, it also can boost immune response parameters when given together with an influenza vaccination15. Studies in infants suggest that it may lower respiratory disease incidence16, but other studies show that it does not decrease illness-related school absenteeism17, 18. Despite a vague picture of its individual effectiveness, it is a popular component of many probiotic supplements, and its genome is even sequenced19.

Bifidobacterium lactis DN-173 010 – Activia

The probiotic strain from Dannon’s Activia is also known as the commercial strain, Bifidus regularis. Unlike B. animalis lactis BB-12, this strain has been studied in isolation and appears to be more suited to treating symptoms associated with irritable bowel syndrome (IBS). Initial studies using mouse models of colitis showed that it could have a positive effect on intestinal inflammation20. Several later studies in humans showed that it could help improve constipation21, 22; bloating, intestinal transit23; and even patient gut well-being24.

Lactobacillus casei DN-114 001 – DanActive

Another functional yogurt from Dannon is the DanActive probiotic yogurt, which contains L. casei DN-114 001, also called L. casei Immunitas. The earliest clinical studies with this probiotic strain examined its ability to prevent diarrhea in children, which showed some success25, 26. Possible mechanisms of action include improving the barrier function of the intestines27, 28, harming bad bacteria29, 30, inhibiting bacterial binding31, and directly controlling the intestinal immune response32, 33. Some studies suggest that it might be helpful in Crohn’s disease31-34. However, there is also a side of this strain that boosts immunity. Like B. animalis lactis BB-12, it seems to help influenza vaccination35 and prevent common infections36-38.

Lactobacillus casei Shirota – Yakult

This strain found in Yakult, infamous for being isolated from a scientist’s own fecal matter, is particularly good at treating chronic constipation39. Patients reported seeing improvements as soon as two weeks after consuming the drink daily. This may be an effect of its ability to manipulate the intestinal microflora40, and it even tackles constipation caused by Parkinson’s disese41. Like the other strains, it appears to help prevent common infections42, 43, and also positively alters immune reactions in those with allergy44 and liver disease45. Unlike the other strains, some studies have addressed its ability to play a role in cancer. These projects have shown that L. casei Shirota can reduce carcinogenic metabolites in the colon46 and reduce recurrences of bladder cancer after surgical treatment47.

Supermarket Medicine

While the studies presented here may look impressive, it’s still wise to cultivate a healthy dose of skepticism when going to the grocery store in search of a solution for a health problem. Let me emphasize: if you are really sick, it is imperative that you visit your doctor. On the other hand, if you are just searching for general support for your health, then a quality probiotic yogurt brand could be great for you, and I even know people that swear by some of them.

As you can also see from the studies, most yogurts are designed for taste and texture and not supporting health. It’s not a coincidence that certain strains are more studied than others; strains really do matter. So, if you’re expecting some health benefits from your probiotic yogurt of choice, check the label first and take a quick look at PubMed and see what’s been published.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.

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References

  1. Firstpost Business – No junk: Pepsi’s entry into US yogurt market comes at the right time – http://www.firstpost.com/business/no-junk-pepsis-entry-into-us-yogurt-market-comes-at-the-right-time-899825.html – accessed September 2, 2013
  2. Forbes – The Yogurt Wars – http://www.forbes.com/sites/marketshare/2013/04/13/the-yogurt-wars/ – accessed September 2, 2013
  3. Dairy Reporter – Top 5 US Yogurt Brands -Yoplait Top, Chobani Toppled, Dannon Trails… http://www.dairyreporter.com/Manufacturers/Top-5-US-Yogurt-Brands-Yoplait-top-Chobani-toppled-Dannon-trails – accessed September 2, 2013
  4. Elli M, Callegari ML, Ferrari S, Bessi E, Cattivelli D, Soldi S, Morelli L, Goupil Feuillerat N, Antoine JM. Survival of yogurt bacteria in the human gut. Appl Environ Microbiol. 2006 Jul;72(7):5113-7.
  5. Mater DD, Bretigny L, Firmesse O, Flores MJ, Mogenet A, Bresson JL, Corthier G. Streptococcus thermophilus and Lactobacillus delbrueckii subsp. Bulgaricus survive gastrointestinal transit of healthy volunteers consuming yogurt. FEMS Microbiol Lett. 2005 Sep 15;250(2):185-7.
  6. García-Albiach R, Pozuelo de Felipe MJ, Angulo S, Morosini MI, Bravo D, Baquero F, del Campo R. Molecular analysis of yogurt containing Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus in human intestinal microbiota. Am J Clin Nutr. 2008 Jan;87(1):91-6.
  7. Aller R, De Luis DA, Izaola O, Conde R, Gonzalez Sagrado M, Primo D, De La Fuente B, Gonzalez J. Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial. Eur Rev Med Pharmacol Sci. 2011 Sep;15(9):1090-5.
  8. Nova E, Toro O, Varela P, López-Vidriero I, Morandé G, Marcos A. Effects of a nutritional intervention with yogurt on lymphocyte subsets and cytokine production capacity in anorexia nervosa patients. Eur J Nutr. 2006 Jun;45(4):225-33. Epub 2006 Mar 7.
  9. Rizkalla SW, Luo J, Kabir M, Chevalier A, Pacher N, Slama G. Chronic consumption of fresh but not heated yogurt improves breath-hydrogen status and short-chain fatty acid profiles: a controlled study in healthy men with or without lactose maldigestion. Am J Clin Nutr. 2000 Dec;72(6):1474-9.
  10. Touhami M, Boudraa G, Mary JY, Soltana R, Desjeux JF. [Clinical consequences of replacing milk with yogurt in persistent infantile diarrhea].[Article in French] Ann Pediatr (Paris). 1992 Feb;39(2):79-86.
  11. Boudraa G, Benbouabdellah M, Hachelaf W, Boisset M, Desjeux JF, Touhami M. Effect of feeding yogurt versus milk in children with acute diarrhea and carbohydrate malabsorption. J Pediatr Gastroenterol Nutr. 2001 Sep;33(3):307-13.
  12. Kekkonen RA, Lummela N, Karjalainen H, Latvala S, Tynkkynen S, Jarvenpaa S, Kautiainen H, Julkunen I, Vapaatalo H, Korpela R. Probiotic intervention has strain-specific anti-inflammatory effects in healthy adults. World J Gastroenterol. 2008 Apr 7;14(13):2029-36.
  13. Wang Z, Wang J, Cheng Y, Liu X, Huang Y. Secreted factors from Bifidobacterium animalis subsp. lactis inhibit NF-κB-mediated interleukin-8 gene expression in Caco-2 cells. Appl Environ Microbiol. 2011 Nov;77(22):8171-4. doi: 10.1128/AEM.06145-11. Epub 2011 Sep 16.
  14. Holscher HD, Czerkies LA, Cekola P, Litov R, Benbow M, Santema S, Alexander DD, Perez V, Sun S, Saavedra JM, Tappenden KA. Bifidobacterium lactis Bb12 enhances intestinal antibody response in formula-fed infants: a randomized, double-blind, controlled trial. JPEN J Parenter Enteral Nutr. 2012 Jan;36(1 Suppl):106S-17S. doi: 10.1177/0148607111430817.
  15. Rizzardini G, Eskesen D, Calder PC, Capetti A, Jespersen L, Clerici M. Evaluation of the immune benefits of two probiotic strains Bifidobacterium animalis ssp. lactis, BB-12® and Lactobacillus paracasei ssp. paracasei, L. casei 431® in an influenza vaccination model: a randomised, double-blind, placebo-controlled study. Br J Nutr. 2012 Mar;107(6):876-84. doi: 10.1017/S000711451100420X. Epub 2011 Sep 7.
  16. Taipale T, Pienihäkkinen K, Isolauri E, Larsen C, Brockmann E, Alanen P, Jokela J, Söderling E. Bifidobacterium animalis subsp. lactis BB-12 in reducing the risk of infections in infancy. Br J Nutr. 2011 Feb;105(3):409-16. doi: 10.1017/S0007114510003685. Epub 2010 Sep 24.
  17. Merenstein DJ, Smith KH, Scriven M, Roberts RF, Sanders ME, Petterson S. The study to investigate the potential benefits of probiotics in yogurt, a patient-oriented, double-blind, cluster-randomised, placebo-controlled, clinical trial. Eur J Clin Nutr. 2010 Jul;64(7):685-91. doi: 10.1038/ejcn.2010.30. Epub 2010 Mar 10.
  18. Merenstein D, Gonzalez J, Young AG, Roberts RF, Sanders ME, Petterson S. Study to investigate the potential of probiotics in children attending school. Eur J Clin Nutr. 2011 Apr;65(4):447-53. doi: 10.1038/ejcn.2010.290. Epub 2011 Feb 16.
  19. Garrigues C, Johansen E, Pedersen MB. Complete genome sequence of Bifidobacterium animalis subsp. lactis BB-12, a widely consumed probiotic strain. J Bacteriol. 2010 May;192(9):2467-8. doi: 10.1128/JB.00109-10. Epub 2010 Feb 26.
  20. Veiga P, Gallini CA, Beal C, Michaud M, Delaney ML, DuBois A, Khlebnikov A, van Hylckama Vlieg JE, Punit S, Glickman JN, Onderdonk A, Glimcher LH, Garrett WS. Bifidobacterium animalis subsp. lactis fermented milk product reduces inflammation by altering a niche for colitogenic microbes. Proc Natl Acad Sci U S A. 2010 Oct 19;107(42):18132-7. doi: 10.1073/pnas.1011737107. Epub 2010 Oct 4.
  21. Tabbers MM, Chmielewska A, Roseboom MG, Boudet C, Perrin C, Szajewska H, Benninga MA. Effect of the consumption of a fermented dairy product containing Bifidobacterium lactis DN-173 010 on constipation in childhood: a multicentre randomized controlled trial (NTRTC: 1571). BMC Pediatr. 2009 Mar 18;9:22. doi: 10.1186/1471-2431-9-22.
  22. De Paula JA, Carmuega E, Weill R. Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation. Acta Gastroenterol Latinoam. 2008 Mar;38(1):16-25.
  23. Agrawal A, Houghton LA, Morris J, Reilly B, Guyonnet D, Goupil Feuillerat N, Schlumberger A, Jakob S, Whorwell PJ. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2009 Jan;29(1):104-14. doi:10.1111/j.1365-2036.2008.03853.x. Epub 2008 Sep 17.
  24. Guyonnet D, Woodcock A, Stefani B, Trevisan C, Hall C. Fermented milk containing Bifidobacterium lactis DN-173 010 improved self-reported digestive comfort amongst a general population of adults. A randomized, open-label, controlled, pilot study. J Dig Dis. 2009 Feb;10(1):61-70. doi: 10.1111/j.1751-2980.2008.00366.x.
  25. Pedone CA, Arnaud CC, Postaire ER, Bouley CF, Reinert P. Multicentric study of the effect of milk fermented by Lactobacillus casei on the incidence of diarrhoea. Int J Clin Pract. 2000 Nov;54(9):568-71.
  26. Pedone CA, Bernabeu AO, Postaire ER, Bouley CF, Reinert P. The effect of supplementation with milk fermented by Lactobacillus casei (strain DN-114 001) on acute diarrhoea in children attending day care centres. Int J Clin Pract. 1999 Apr-May;53(3):179-84.
  27. Zakostelska Z, Kverka M, Klimesova K, Rossmann P, Mrazek J, Kopecny J, Hornova M, Srutkova D, Hudcovic T, Ridl J, Tlaskalova-Hogenova H. Lysate of probiotic Lactobacillus casei DN-114 001 ameliorates colitis by strengthening the gut barrier function and changing the gut microenvironment. PLoS One. 2011;6(11):e27961. doi: 10.1371/journal.pone.0027961. Epub 2011 Nov 22.
  28. Llopis M, Antolín M, Guarner F, Salas A, Malagelada JR. Mucosal colonisation with Lactobacillus casei mitigates barrier injury induced by exposure to trinitronbenzene sulphonic acid. Gut. 2005 Jul;54(7):955-9.
  29. Sýkora J, Valecková K, Amlerová J, Siala K, Dedek P, Watkins S, Varvarovská J, Stozický F, Pazdiora P, Schwarz J. Effects of a specially designed fermented milk product containing probiotic Lactobacillus casei DN-114 001 and the eradication of H. pylori in children: a prospective randomized double-blind study. J Clin Gastroenterol. 2005 Sep;39(8):692-8.
  30. Fayol-Messaoudi D, Berger CN, Coconnier-Polter MH, Liévin-Le Moal V, Servin AL. pH-, Lactic acid-, and non-lactic acid-dependent activities of probiotic Lactobacilli against Salmonella enterica Serovar Typhimurium. Appl Environ Microbiol. 2005 Oct;71(10):6008-13.
  31. Ingrassia I, Leplingard A, Darfeuille-Michaud A. Lactobacillus casei DN-114 001 inhibits the ability of adherent-invasive Escherichia coli isolated from Crohn’s disease patients to adhere to and to invade intestinal epithelial cells. Appl Environ Microbiol. 2005 Jun;71(6):2880-7.
  32. Carol M, Borruel N, Antolin M, Llopis M, Casellas F, Guarner F, Malagelada JR. Modulation of apoptosis in intestinal lymphocytes by a probiotic bacteria in Crohn’s disease. J Leukoc Biol. 2006 May;79(5):917-22.
  33. Llopis M, Antolin M, Carol M, Borruel N, Casellas F, Martinez C, Espín-Basany E, Guarner F, Malagelada JR. Lactobacillus casei downregulates commensals’ inflammatory signals in Crohn’s disease mucosa. Inflamm Bowel Dis. 2009 Feb;15(2):275-83. doi: 10.1002/ibd.20736.
  34. Hacini-Rachinel F, Nancey S, Boschetti G, Sardi F, Doucet-Ladevèze R, Durand PY, Flourié B, Kaiserlian D. CD4+ T cells and Lactobacillus casei control relapsing colitis mediated by CD8+ T cells. J Immunol. 2009 Nov 1;183(9):5477-86. doi: 10.4049/jimmunol.0804267.
  35. Boge T, Rémigy M, Vaudaine S, Tanguy J, Bourdet-Sicard R, van der Werf S. A probiotic fermented dairy drink improves antibody response to influenza vaccination in the elderly in two randomised controlled trials. Vaccine. 2009 Sep 18;27(41):5677-84. doi: 10.1016/j.vaccine.2009.06.094. Epub 2009 Jul 16.
  36. Guillemard E, Tanguy J, Flavigny A, de la Motte S, Schrezenmeir J. Effects of consumption of a fermented dairy product containing the probiotic Lactobacillus casei DN-114 001 on common respiratory and gastrointestinal infections in shift workers in a randomized controlled trial. J Am Coll Nutr. 2010 Oct;29(5):455-68.
  37. Merenstein D, Murphy M, Fokar A, Hernandez RK, Park H, Nsouli H, Sanders ME, Davis BA, Niborski V, Tondu F, Shara NM. Use of a fermented dairy probiotic drink containing Lactobacillus casei (DN-114 001) to decrease the rate of illness in kids: the DRINK study. A patient-oriented, double-blind, cluster-randomized, placebo-controlled, clinical trial. Eur J Clin Nutr. 2010 Jul;64(7):669-77. doi: 10.1038/ejcn.2010.65. Epub 2010 May 19.
  38. Guillemard E, Tondu F, Lacoin F, Schrezenmeir J. Consumption of a fermented dairy product containing the probiotic Lactobacillus casei DN-114001 reduces the duration of respiratory infections in the elderly in  a randomised controlled trial. Br J Nutr. 2010 Jan;103(1):58-68. doi: 10.1017/S0007114509991395. Epub 2009 Sep 14.
  39. Koebnick C, Wagner I, Leitzmann P, Stern U, Zunft HJ. Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Can J Gastroenterol. 2003 Nov;17(11):655-9.
  40. Barrett JS, Canale KE, Gearry RB, Irving PM, Gibson PR. Probiotic effects on intestinal fermentation patterns in patients with irritable bowel syndrome. World J Gastroenterol. 2008 Aug 28;14(32):5020-4.
  41. Cassani E, Privitera G, Pezzoli G, Pusani C, Madio C, Iorio L, Barichella M. Use of probiotics for the treatment of constipation in Parkinson’s disease patients. Minerva Gastroenterol Dietol. 2011 Jun;57(2):117-21.
  42. Gleeson M, Bishop NC, Oliveira M, Tauler P. Daily probiotic’s (Lactobacillus casei Shirota) reduction of infection incidence in athletes. Int J Sport Nutr Exerc Metab. 2011 Feb;21(1):55-64.
  43. Van Puyenbroeck K, Hens N, Coenen S, Michiels B, Beunckens C, Molenberghs G, Van Royen P, Verhoeven V. Efficacy of daily intake of Lactobacillus casei Shirota on respiratory symptoms and influenza vaccination immune response: a randomized, double-blind, placebo-controlled trial in healthy elderly nursing home residents. Am J Clin Nutr. 2012 May;95(5):1165-71. doi: 10.3945/ajcn.111.026831. Epub 2012 Mar 21.
  44. Ivory K, Chambers SJ, Pin C, Prieto E, Arqués JL, Nicoletti C. Oral delivery of Lactobacillus casei Shirota modifies allergen-induced immune responses in allergic rhinitis. Clin Exp Allergy. 2008 Aug;38(8):1282-9. doi: 10.1111/j.1365 2222.2008.03025.x. Epub 2008 May 28.
  45. Stadlbauer V, Mookerjee RP, Hodges S, Wright GA, Davies NA, Jalan R. Effect of probiotic treatment on deranged neutrophil function and cytokine responses in patients with compensated alcoholic cirrhosis. J Hepatol. 2008 Jun;48(6):945-51. doi: 10.1016/j.jhep.2008.02.015. Epub 2008 Mar 25.
  46. De Preter V, Raemen H, Cloetens L, Houben E, Rutgeerts P, Verbeke K. Effect of dietary intervention with different pre- and probiotics on intestinal bacterial enzyme activities. Eur J Clin Nutr. 2008 Feb;62(2):225-31. Epub 2007 Feb 28.
  47. Naito S, Koga H, Yamaguchi A, Fujimoto N, Hasui Y, Kuramoto H, Iguchi A, Kinukawa N, Prevention of recurrence with epirubicin and lactobacillus casei after transurethral resection of bladder cancer. J Urol. 2008 Feb;179(2):485-90.