According to Bonnie Taub-Dix, MA, RD, CDN, founder of Better Than Dieting and author of Read It Before You Eat It, “We have more bacterial cells in our body than actual tissue, so you want as much “good” bacteria to be on your side. But not all probiotics are alike, and how your body reacts to them will not be the same as someone else who takes them.”
Consuming probiotics regularly will reduce the risk of this. "The concept is that if we have an unhealthy, unbalanced gut environment, toxins can be released into the bloodstream and cause inflammation throughout the body," Engelman adds. "This shift in gut flora and the subsequent inflammation can cause a flare-up in the skin of those who are predisposed to acne, eczema, or rosacea." 

You'd be right. Lebwohl said there are no current studies supporting probiotics for cancer, and further, that he’d be concerned about anyone with a compromised immune system using probiotics. “It has not been adequately studied for cancer and I would be concerned about widespread probiotic use in someone who might have a suppressed immune system due to cancer, because of the rare but documented instances of actual infections arising from probiotic use."
The above line of probiotics is also a favorite of Engelman. "I like Nerium International's new Prolistic Pre & Probiotic Plus Vitamins ($45) because it combines prebiotics, probiotics, and vitamins," Engelman explains. "It supports overall health while targeting digestive function. It contains two types of prebiotics and two strains of probiotics to help enhance levels of beneficial microflora and balance levels of healthy bacteria in the digestive system. Additionally, it contains B vitamins, vitamin C, and vitamin D, which work to enhance the body's immune system and support natural energy production."
About 60 to 80 percent of our immune system lives in our gut. Imbalances in the gut’s microbiome (which is primarily made up of bacteria) lead to digestive issues, while many many other potential effects can be felt throughout the body—from feelings of fatigue to depression, thyroid dysfunction, autoimmunity, and a host of skin issues. Conditions like rosacea, psoriasis, eczema, and acne are really inflammatory conditions, and often a manifestation of something that is happening deeper within the body. When you fix the gut (which, depending on your health, might include getting rid of an infection like Candida, eating a clean diet, and taking a probiotic), skin issues often resolve as well.
The good news keeps stacking up for probiotics, the good-for-you bacteria that keep your GI system functioning in tip-top shape. "Research is finding that a healthy microbiome may play a role in reducing inflammation, a risk factor involved in illnesses ranging from colds to cancer, heart disease, arthritis, and cognitive decline," says Katherine Tallmadge, RD, author of Diet Simple. In addition, the bacteria may help burn body fat and reduce insulin resistance, she says. So to stay slim and healthy, consider adding more probiotic foods to your diet. Start with these truly yummy 13.
There is one Voluntary Certification Program by which a supplement manufacturer can choose to be evaluated. ConsumerLab.com (CL) is the leading provider of independent test results and information to help consumers and health-care professionals identify the best quality health and nutrition products. Products that have passed their testing for identity, strength, purity, and disintegration can print the CL Seal of Approval on their product. This is one step toward being confident that one is getting the amount and type of probiotic promised by the manufacturer.
Cynthia is the assistant editor and frequent contributor. She’s originally from California, but has lived in many countries including South Korea, China and Germany. She currently lives with her husband in Minnesota. Cynthia is passionate about helping families find the best advice for family life and safety. Cynthia also has experience in early childhood education and holds a TEFL-C certificate from Teachers College, Columbia University. She has been writing about family-focused topics, advice and trends since 2014.
Experts agree that this is the most important factor to consider in choosing a probiotic. "You should absolutely choose a probiotic based on what you are looking to address," says Chang. "Because strain specificity will impact outcomes, it is important to consider that one strain that works for one condition will not necessarily be effective for other conditions."
Many wondered whether probiotics could be therapeutic in other gastrointestinal disorders. Unfortunately, that doesn’t appear to be the case. Probiotics didn’t show a significant benefit for chronic diarrhea. Three reviews looked at how probiotics might improve Crohn’s disease, and none could find sufficient evidence to recommend their use. Four more reviews looked at ulcerative colitis, and similarly declared that we don’t have the data to show that they work. The same was true for the treatment of liver disease.
The price is great on these, but definitely BEWARE! I do not recommend taking 2 pills in the beginning if you have not taken probiotics in the past! I had been eating very clean for a couple months, but got a sinus infection and was recommended by a nutritionist to take a probiotic to boost gut health since I was on antibiotics. Anyway-taking 2 pulls a day gave me horrible diarrhea, until I figured out they were causing the issue and cut back the pills to one a day! Everything fine since then, will try to build back up to 2 a day...I also take at bedtime just in case there would be any stomach issues!

The second type of probiotics are soil-based organisms (SBO), which tend to be more resistant to acid in the gut. Here’s the thinking behind soil-based probiotics: Many people (particularly in the paleo community) believe that widespread gut and health issues today are the result of life in a too-clean society. In the past, when more people worked in the dirt, played in the dirt, there was less obsessing over cleanliness and antibacterial products, we got more natural exposure to probiotics. The benefit of soil-based probiotics is that they come from the earth, and the bacteria (which are still living) have their own natural, protective capsule surrounding them. I recommend soil-based probiotics to patients with autoimmunity, in addition to the classic form. They are particularly helpful for people with SIBO (small intestinal bacterial overgrowth)—with SIBO, you also have an overgrowth of good bacteria; and in this case, the classic form of probiotic is not what you need to fight the infection.
You may have heard that taking vitamin C or zinc is helpful, preventively or during sickness. This is because vitamin C and zinc improve the functioning of cells of your innate immunity, your first line of defense against pathogens like the flu. They also are involved in the generation of and protection against the inflammatory response caused by the battle with the flu.

But sometimes you need a little help from outside sources in order to secure those benefits, which is why a lot of experts recommend getting an extra hit of probiotics through food. Fermented options — think keffir, sauerkraut, and kimchi — are a great place to start, says the International Scientific Association of Probiotics and Prebiotics, as are these other surprising foods with probiotics.


Then, study participants were divided into one group that consumed a standard probiotic strain available in commercial supplements and a control group that was given a placebo. After two months of treatment, the researchers found that some people were so-called “resisters” who expelled the gut microbiomes in probiotics; others were identified as “persisters” who successfully colonized the generic probiotic strains in their GI tracts.
This cabbage condiment can frequently be found atop a mighty hot dog, but its roots trace all the way back to the 4th century B.C. Cabbage was fermented to preserve the veggie, resulting in what we all know as sauerkraut. Palmer points out that modern techniques for canning sauerkraut results in a product packed in a vinegar solution without live, active bacteria in the mix. For most probiotic power, eat fresh sauerkraut (look for live cultures on the label or buy it in the refrigerated section) or make it yourself at home.
Previous studies have been contradictory, with some yielding more positive results about the benefits of probiotics, but most of them looked at probiotics in stool samples, not directly in the gut itself. In the new research, the scientists used more invasive methods to take samples of gut bacteria directly from different areas of the digestive system.
It’s great to get some healthy sour foods. I often add one tablespoon of apple cider vinegar to a drink, twice a day. Before breakfast and lunch or breakfast and dinner, add one tablespoon of apple cider vinegar in your meal, and then start consuming more fermented vegetables like sauerkraut and kimchi, or drinking kvass. Is apple cider vinegar a probiotic itself? No, but apple cider vinegar probiotic content makes it an excellent source of probiotics benefits.
They probably are. Lebwohl says probiotics may decrease the risk of getting diarrhea during the course of taking antibiotics, and may also play a role in specifically preventing the development of the dreaded antibiotic-related super diarrhea called C. difficile or C. diff. Antibiotics can wipe out the good bacteria that keep you from getting sick if you’re exposed to C. diff, or if you already have it in your system. C. diff symptoms can range from a moderate watery diarrhea several times a day to severe infections, which can be accompanied by fever, bloody stools, rapid heart rate, and can even lead to kidney failure. 500,000 Americans were infected with C. diff in 2015 and 15,000 died from it.
Probiotics stick around for a while, though for how long isn’t precisely clear. You have to keep taking them to continue to reap the benefits. Further, getting a wide variety of strains into your system is beneficial. “Periodically mixing up your probiotic supplement is also a good way to ensure that you get different health-building strains in your health regime,” says Dr. Cook.
That's because issues that can be treated with probiotics stem from specific imbalances in the amount of certain bacterial strains, according to Elena Ivanina, M.D., a gastroenterologist at Lenox Hill Hospital. "Therefore, if someone decides to supplement a particular strain of Lactobacillus, but they already have enough of that strain in their gut and their disease does not stem from a lack of Lactobacillus, then they will not have a response." Makes sense, right?
Also, it’s important to understand that probiotics are not a new idea. Throughout history, cultures have thrived on probiotics found in fermented foods and cultured foods, which were invented for food preservation long before the refrigerator. The process of fermentation has been lost in recent years, as it is no longer needed to preserve foods, meaning that we now lose out on those vital probiotics benefits.
“Some strains have been shown to help with GI complaints, some with immune function, and some even have been shown to have benefits outside the intestinal tract, such as with vaginal health or eczema,” says Gail Cresci, Ph.D., R.D., a Cleveland Clinic researcher who studies the microbiome. But there are few definitive conclusions from the current research.
The second piece of research investigated whether patients should take probiotics to help the recovery of the natural gut bacteria after treatment with antibiotics. The evidence supporting this is not entirely clear and the FDA does not officially recommend it, but there are some reputable sources which discuss their use, such as this blog from Harvard Medical School. Research has suggested that up to 60% of healthcare professionals in the U.S. recommend taking probiotics, but is this justified and could it even be harmful?
Digestive Advantage is one of the better probiotics available today. With 2 billion live cells in each capsule, it makes for a good daily probiotic for digestive and immune health. This probiotic claims that it can survive in your digestive system up to 10x better than yogurt. If this fact holds true, taking a supplement like this is much quicker and possibly more efficient than eating spoonfuls of yogurt everyday!  Overall, Digestive Advantage succeeds in being a great probiotic that’s a great value and can be taken every day!  Read the full review here… or click here to go buy it now!
"Contrary to the current dogma that probiotics are harmless and benefit everyone, these results reveal a new potential adverse side effect of probiotic use with antibiotics that might even bring long-term consequences," Elinav says. "In contrast, replenishing the gut with one's own microbes is a personalized mother-nature-designed treatment that led to a full reversal of the antibiotics' effects."
Sugar is so easily accessible in Westernized cultures that it is easy to overindulge in it. But why do you crave it? There are several reasons. One, sugar usually means sucrose, which is composed of glucose and fructose. Glucose is the sugar in your blood, so consumption of sugar results in a temporary boost of energy. However, that blood-sugar spike causes insulin to be released to usher the sugar into cells for energy or fat storage, and shortly afterward your blood sugar drops. So then you feel a slump and reach for something to bring your blood sugar back up: more sugar.

Though capsules are ideal for quick, convenient consumption, powdered products are a great choice for anyone who wants to mix their probiotics with shakes or smoothies. The Hyperbiotics Organic Prebiotic Powder is a totally taste-free prebiotic powder that has inulin, FOS, resistant starch, and dietary fiber to help keep your gut health in line. Unlike probiotics, prebiotics works to nourish and grow the bacteria that is already in your body. This supplement also has acacia fiber, which is said to help suppress appetite and reduce gas and bloating. You can take between one and three scoops of powder a day, depending on how much microbial support you’re looking for. Each container comes with 375 grams or roughly 54 servings, and it doesn’t need to be refrigerated.
Helicobacter pylori (H. pylori) is a bacteria that causes chronic inflammation (gastritis) of the inner lining of the stomach, and also is the most common cause of ulcers worldwide. About 50% of people in the world carries or is infected with H. pylori. Common symptoms of H. pylori infection are occasional abdominal discomfort, bloating, belching or burping, and nausea and vomiting. H. pylori infection is difficult to erdicate, and treatment is with two or more antibiotics.
What about prebiotics vs probiotics? Prebiotics are the food fibers that go through the gut unchanged and are then used by good colon bacteria as a food source for their own growth. Everyone already has most of these good bacteria present, but often in small quantities. Prebiotics are used to stimulate their growth. Simply stated, you already grow your own probiotics within your colon. You do not rely on them to make the passage through the stomach acid — acid that can destroy many probiotic bacteria. That’s why taking a probiotic supplement or adding probiotic foods to your diet does not always help your digestive system. You can eat as many probiotic bacteria as you want, but if they don’t survive the trip to the colon, your effort will be fruitless.
The term "prebiotics" is often thrown around when probiotics are mentioned, and they're related to probiotics in a sense. According to Angelone, prebiotics are complex sugars that we don't digest but that are used as fuel by bacteria — including probiotics — that's already in your gut. Registered dietitian-nutritionist Beth Warren, founder of Beth Warren Nutrition and author of Living a Real Life with Real Food, explains that you can think of prebiotics as food for probiotics. You can get prebiotics from foods including asparagus, bananas, garlic, and onions, she says.
Hi Joan, it’s possible, but not ideal because most pill form probiotic supplements are designed to be protected from stomach acid until the capsule reaches the intestines. It’s impossible to say how many probiotic microorganisms would survive by taking them this way, but certainly less than if you swallow the pills. I would recommend trying a probiotic gummy product or some other probiotic that comes in something other than pill form rather than opening up the capsules.
A 2017 survey of cancer patients showed that more than 80 percent were taking some sort of dietary supplement, vitamin, mineral, or herb to treat digestive issues they were experiencing due to chemotherapy. Researchers noted that while supplements can be beneficial in some cases, they can also change the metabolism of anti-cancer drugs, or lead to life-threatening conditions like sepsis because of the patient’s compromised immune system. 

The science on what probiotics do is still emerging. There is some hard evidence that suggests eating probiotic foods and supplements can have a beneficial effect on health. Other evidence suggests probiotics benefits are limited to those individuals in good health and should be avoided by those who suffer from certain serious health conditions. There is no research that demonstrates the risks or the benefits of probiotic supplements on children.
"Although all of our probiotic-consuming volunteers showed probiotics in their stool, only some of them showed them in their gut, which is where they need to be," says Segal. "If some people resist and only some people permit them, the benefits of the standard probiotics we all take can't be as universal as we once thought. These results highlight the role of the gut microbiome in driving very specific clinical differences between people."
We started our search with the most popular products from major supplement retailers like Amazon, Drugstore.com, GNC, and Whole Foods. That gave us over 200 supplements. With so many options, we then narrowed our search to 70 probiotics whose purity, potency, and projected efficacy have been vetted by an independent lab like ConsumerLab, Labdoor or the National Science Foundation (NSF). Those labs test — among other things — supplements’ actual composition against labels, verifying ingredient lists are truthful and that contaminants aren’t present. Because supplement claims aren’t regulated by the Food and Drug Administration (FDA), we wanted to make sure someone was testing whether they worked as described.

Antibiotics are also a major contributor to gut imbalances. Many of us have been overprescribed antibiotics by well-meaning, conventional doctors from childhood onward. Antibiotic use as a solution for every infection is ingrained in our culture. Every time you take an antibiotic throughout your life, you disrupt your gut flora for up to 12 months.
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It is well known that people with lactose intolerance can often consume yogurt with few symptoms. This is because the probiotics in yogurt help digest the lactose in the small intestine, before it reaches the colon. In addition, the yogurt starter cultures L. bulgaricus and Streptococcus thermophilus help to break down the lactose. Because of its probiotics, yogurt is a good way for people with lactose intolerance to consume the recommended servings of dairy without experiencing uncomfortable symptoms they may get from other dairy products.
Thankfully, most causes of constipation can be improved with dietary and lifestyle interventions. One of probiotics benefits is constipation relief. Probiotics of many kinds can help with constipation because they can keep the digestive contents moving along through different mechanisms such as short-chain fatty acid production, influences on the nerves of the digestive tract, electrolyte balance, pathogen control, and others. Think of probiotic foods and pills as an addition to other dietary and lifestyle interventions to relieve constipation and return your digestive system to its normal functions.
In the first study, 25 human volunteers underwent upper endoscopies and colonoscopies to sample their baseline microbiome in regions of the gut. 15 of those volunteers were then divided into two groups. The first group consumed generic probiotic strains, while the second was administered a placebo. Both groups then underwent a second round of upper endoscopies and colonoscopies to assess their internal response before being followed for another 2 months.
Probiotics contain 'good' bacteria, and that's exactly why we need them; because it's not just 'good' bacteria calling our gut home. Taking a probiotic supplement (along with a healthy diet) increases the number of good bacteria, reduces the number of bad bacteria and creates an environment that’s suitable for beneficial microorganisms, which improves our overall health.
However, it is not just digestive woes that probiotics can help address. A clinical case series followed 300 patients who took a probiotic mixture of L. acidophilus and L. Bulgaricus. They documented that 80% of acne patients had some degree of clinical improvement, particularly effective in inflammatory acne. Later, an Italian study involving 40 patients found L. Acidophilus and B. Bifidum supplementation produced better clinical outcomes in acne as well as better tolerance and compliance with antibiotics [2].
Deep Immune Support Probiotics started with a simple premise: Most probiotic strains present on the market today cannot survive the acidic environment of the human digestive system. Additionally, most of the most powerful probiotics require refrigeration, meaning they won’t survive standard delivery services or even room temperatures during your commute or travel.
Notions don’t equal evidence though, and Lebwohl cautioned against thinking of probiotics as a cure-all, and examining the ways in which they’ve been proven to work as well as the ways in which they really haven’t. So which medical conditions have probiotics actually shown promise in treating and which claims have the credibility of a used car salesman on acid?
Two large-scale clinical trials recently reported in the New England Journal of Medicine suggest that the situation in infectious diarrhoea might also be more complex than previously believed. Freedman and colleagues did a randomised controlled trial of a probiotic containing Lactobacillus rhamnosus and Lactobacillus helveticus in children presenting to the emergency department with gastroenteritis. Contrary to expectations, they found that the probiotic did not prevent development of moderate-to-severe gastroenteritis within 14 days after enrolment. In a separate study, Schnadower and colleagues found similar results with L rhamnosus GG alone. Both trials used probiotics that are available over the counter in North America and showed no significant difference from placebo in the duration of diarrhoea and vomiting, number of unscheduled health-care visits, or length of absence from day care. These results cannot be generalised to other probiotic strains or preparations, but they do show that we have some way to go in elucidating which probiotics might provide benefits in which clinical settings.
The term "prebiotics" is often thrown around when probiotics are mentioned, and they're related to probiotics in a sense. According to Angelone, prebiotics are complex sugars that we don't digest but that are used as fuel by bacteria — including probiotics — that's already in your gut. Registered dietitian-nutritionist Beth Warren, founder of Beth Warren Nutrition and author of Living a Real Life with Real Food, explains that you can think of prebiotics as food for probiotics. You can get prebiotics from foods including asparagus, bananas, garlic, and onions, she says.
However, these quality of life improvements are varied, and some improvements are quite mild. Sample group, types of allergies, symptoms, and results are across a broad spectrum. For example, numerous studies have shown that allergic rhinitis responses to the household dust mite decrease significantly in adults and children when probiotics were used. However, people allergic to birch pollen saw neither a decrease in general allergic responses to birch pollen or to apple food.
Do you strain with infrequent bowel movements? Do the feces look like separate hard lumps or like bunches of hard lumps stuck together, or are they pencil-thin? You may have constipation. The Bristol stool chart (BSC) was developed by two doctors as a way to differentiate between states of constipation, normal elimination, a state of lacking fiber, and states of inflammation. Stools are supposed to be long and sausage-like, with few or no cracks in the surface.
Supplements play an important role when the diet is not adequate to supply our needs. In the case of probiotics, one's diet is the ideal source for probiotics. These are live bacteria and need to be carefully monitored, stored, and combined for the health benefits that one would be taking them for. At this time, supplements are not monitored in the U.S. the way that food or medication is. They fall under the Dietary Supplement Health and Education Act of 1994 (DSHEA). This requires that the dietary supplement or dietary ingredient manufacturer be responsible for ensuring that a dietary supplement or ingredient is safe before it is marketed. The only time that the U.S. Food and Drug Administration (FDA) may get involved is if action is needed to be taken against a manufacturer after the supplement is marketed and then found to be unsafe. This means that as much as we may know about probiotics, we can't be certain of the safety or content of the supplements available to us.
Florastor uses the unique strain Saccharomyces boulardii lyo, which works to strengthen digestive balance and boost immunity. To boost immunity, Florastor stimulates the production of immunoglobulin A — an antibody that helps defend your body against infection. If you’re on long-term antibiotics, this will be a good option for you as Florastor is genetically resistant to antibiotics. When taking a probiotic supplement at the same time as an antibiotic, Gans advises waiting at least two hours in between. Each box contains 50 capsules. Take one to two capsules per day.
Most probiotics are like what is already in a person's digestive system. Some probiotics have been used for a very long time throughout history, such as in fermented foods and cultured milk products. These don't appear to cause illness. But more study is needed on the safety of probiotics in young children, the elderly, and people who have weak immune systems.
The authors discuss the need for “pscyhobiotics” (probiotics that impact brain function) in handling the development of these conditions. This anti-inflammatory quality is what seems to interest researchers most. While no studies have been conducted in humans, early research suggests that, in animals, probiotic supplements may help alleviate symptoms of anxiety by reducing inflammation along this gut-brain connection.
The other way that probiotics help is the impact that they have on our immune system. Some believe that this role is the most important. Our immune system is our protection against germs. When it doesn't function properly, we can suffer from allergic reactions, autoimmune disorders (for example, ulcerative colitis, Crohn's disease, and rheumatoid arthritis), and infections (for example, infectious diarrhea, H. pylori, skin infections, and vaginal infections). By maintaining the correct balance from birth, the hope would be to prevent these ailments. Our immune system can benefit anytime that balanced is restored, so it's never too late. 

Side effects: Probiotics are considered safe overall for healthy people; short-term side effects may include mild gas and bloating. But risks may be greater in immunocompromised people. And a systematic review in the Annals of Internal Medicine in 2018 found that the reporting of adverse effects is often missing or inadequate. Also in 2018, an editorial in JAMA Internal Medicine by Dr. Pieter Cohen, a well-known critic of the supplements industry, called for the FDA to improve its regulatory standards for probiotics to match those of Canada and the EU.

A Seal of Approval When looking for a good probiotic, Gans advises consumers to buy from a trusted retailer and look for a seal from a third-party certifier. “Reputable probiotic supplements should list the genus, species, and strain, in addition to the number of organisms that will be alive by the use-by date and the dose on the label,” says Gans. This transparency will help consumers understand what’s in their supplement and how to best use it.
“I’d probably stay away from store brands and pay a little extra for the name brand that’s been studied,” Dr. Cresci adds. “Ideally, look for a product that’s been tested for whatever you’re looking to address. It might say it helps with IBS, but you wouldn’t take that same product if you were taking antibiotics. You would want a product that helps with immunity. That’s where a lot of people get confused.”
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
Since the bulk of your natural flora exists in your gut, it makes sense that this is the part of your body that feels it most when bacteria become imbalanced. Women, in particular, can experience all kinds of digestive problems, particularly during hormone fluctuations. These are just some of the digestive symptoms a high-quality probiotic can help reduce and even treat:
More than 80 years later, probiotics have become wildly popular and incredibly profitable. A 2012 survey by the National Institutes of Health showed that 3.9 million Americans stated they had used some form of probiotics or prebiotics (a type of dietary fiber thought to feed the friendly bacteria in your gut) in the last 30 days—3 million more people than in the previous study in 2007. Probiotics are now available for consumption in almost every imaginable form—pills, tablets, yogurts, juices, cereals, and energy bars. They have been touted as having benefits not only for digestive health, but also mood disorders, cancer, cold and flu prevention, and reproductive health issues.
Let’s start at the very beginning: probiotics are bacteria. We know what you’re thinking, bacteria cause infections and are just generally kind of gross. Well, in some aspects, you’re absolutely right. But when it comes to your digestive and feminine health, some bacteria are teeny tiny miracle workers that can make all the difference in the way you feel!
As with other types of supplements, scientists are still discovering the full potential of probiotics. However, when taken regularly, it is believed that they help support digestive health by helping maintain the balance of beneficial and non-beneficial bacteria in your digestive tract. Having a natural balance of good bacteria in the digestive tract can help defend against occasional digestive issues. In addition, probiotics play an important role in supporting immune health, since 70% of the body's immune system is found in the digestive tract.∗
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