Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Once the GI microbiome is disrupted, and especially if an infection is treated with antibiotics, it can take time for the resident microbiota to recover, if it ever does. A disrupted gut microbiome sets the stage for altered motility, intestinal hypersensitivity, gut immune activation, leaky gut, altered bile, mental disorders, and a host of other factors that can play a role in IBS. Good probiotics, along with a proper diet, can help the GI tract get the microbes it needs to function normally.
 Do you ever feel like your thinking is clouded, where it is hard to think, hard to focus, and hard to recall events that happened recently? You may have a case of brain fog. Brain fog is a group of neurocognitive symptoms that make a person feel groggy and not quite “with it.” There are many causes, such as lack of sleep, a hangover, fever and illness, neurotoxins such as MSG, chronic inflammation, infections, autoimmune disease, heavy metals toxicity, consumption of reactive foods, vitamin deficiencies, blood sugar fluctuations, hormonal fluctuations, and bacterial by-products. The end result is neuroinflammation, which causes the clouded thinking.

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.
Keep in mind that when supplements contain a specific number of organisms, this number may not be what is actually within each capsule at the time of purchase. Probiotics are living organisms and can die out easily. Especially if that supplement sits on your drugstore or warehouse shelf for months or longer, the number of organisms you get may be far less than what the bottle claims. Hardier strains have a longer shelf life. Capsule strength decays faster if the probiotic has been sitting around at elevated temperatures during transport to the store. Companies actually have to produce probiotics with a much higher CFU (colony-forming units; see below) count in each capsule in order to guarantee the label potency by the expiration date.
This is also known as S. boulardii and is the only yeast probiotic. Some studies have shown that it is effective in preventing and treating diarrhea associated with the use of antibiotics and traveler's diarrhea. It has also been reported to prevent the reoccurrence of C. difficile, to treat acne, and to reduce side effects of treatment for H. pylori.
Following a healthy and active lifestyle and eating a balanced diet are the best ways to foster a bountiful gut flora. Taking care of your gut flora can help with things like irritable bowel syndrome and chronic constipation, among other things. Even if you’re not sold on pursuing probiotics for your allergies, they’re good to consider if you’re experiencing any gastrointestinal issues.
Directions Take 2 Vegetarian Capsules with or without food. As a dietary supplement, take two (2) capsules once daily. For best results, take one (1) capsule during the day and one (1) capsules in the evening. Repeat the process daily. Do not exceed two capsules per day. As a dietary supplement, take one (1) veggie probiotic capsule once daily. Because our probiotic uses delayed release capsules, do not chew or crush. Our capsules help ensure the active probiotic strains reach your intestinal tract. Adults take 1 capsule daily. May be taken with or without food. Capsules can be opened. Contents can be taken directly with water or juice. Not intended for children.
On my recent trip to Japan, one thing I noticed was the inclusion of pickled vegetables in almost every traditional Japanese meal. Unfortunately, many Americans don’t consume enough of these probiotic-rich foods and drinks. Even when they do, restoring equilibrium oftentimes requires therapeutic doses of these microorganisms, because most everyone has been on several rounds of antimicrobials. That’s where a probiotic supplement comes in.
One review of probiotics benefits for necrotizing enterocolitis was bold enough to say, “The results confirm the significant benefits of probiotic supplements in reducing death and disease in preterm neonates. The … evidence indicate that additional placebo-controlled trials are unnecessary if a suitable probiotic product is available.” Regarding sepsis in developing countries (where it is overwhelmingly more common), a 2017 randomized, controlled trial claims that a large number of these cases “could be effectively prevented” if mothers are given a synbiotic (probiotic and prebiotic together) that contains the probiotic strain L. plantarum.
Probiotics for allergies are fast becoming a preferred treatment method because they are understood to be much safer than traditional allergic rhinitis medication. A nasal spray for allergies is often a ‘go to’ treatment, for example, but allergy nose spray medications often contain corticosteroids, like Beclometasone dipropionate, which could affect bone metabolism, blood cells, and the pituitary gland.
If you get sick often, probiotics might be the immune booster you've been looking for. The Cleveland Clinic says they've been shown to strengthen immunity by enriching and replenishing the good bacteria in the body. And when you eat foods with probiotics regularly, it's easier for your body to produce vitamins and enzymes that help keep your intestines happy.
L. Casei also made headlines when a study found it beneficial in relieving anxiety. The randomized, double-blind, placebo-controlled pilot study found supplementation with 24 billion units of the L. Casei strain Shirota led to a rise in probiotics Lactobacillus and Bifidobacterium, as well as a significant decrease in symptoms of anxiety and depression [2].
When shopping for a probiotic, the first things to look at are CFUs count and probiotic strains. CFUs is the acronym for colony forming units, and is the measure of how many probiotic bacteria are capable of dividing to form colonies. In other words, the higher the CFUs, the higher the number of active, live good bacteria. Generally speaking, the higher the CFUs, the better, although there are exceptions.
If this happens, it's time to consider switching to a new probiotic. Other reasons a probiotic may not be the right fit: SIBO or Candida. If you have either of these conditions, the strain of the probiotic could potentially make your symptoms worse. Remember, if you think a probiotic is not helping, seek the advice of a functional medicine provider to help you navigate the choices out there.
Probiotics' side effects, if they occur, tend to be mild and digestive (such as gas or bloating). More serious effects have been seen in some people. Probiotics might theoretically cause infections that need to be treated with antibiotics, especially in people with underlying health conditions. They could also cause unhealthy metabolic activities, too much stimulation of the immune system, or gene transfer (insertion of genetic material into a cell).
Even if some of the bacteria in a probiotic managed to survive and propagate in the intestine, there would likely be far too few of them to dramatically alter the overall composition of one's internal ecosystem. Whereas the human gut contains tens of trillions of bacteria, there are only between 100 million and a few hundred billion bacteria in a typical serving of yogurt or a microbe-filled pill. Last year a team of scientists at the University of Copenhagen published a review of seven randomized, placebo-controlled trials (the most scientifically rigorous types of studies researchers know how to conduct) investigating whether probiotic supplements—including biscuits, milk-based drinks and capsules—change the diversity of bacteria in fecal samples. Only one study—of 34 healthy volunteers—found a statistically significant change, and there was no indication that it provided a clinical benefit. “A probiotic is still just a drop in a bucket,” says Shira Doron, an infectious disease expert at Tufts Medical Center. “The gut always has orders of magnitude more microbes.”
If you’re looking for a great probiotic you can take every day to target everything from gut to skin health, the Culturelle Daily Probiotic is our top choice. Each capsule has 10 billion active cultures of 100 percent Lactobacillus GG, a probiotic that helps curb gas, bloating, and upset stomach, and works to boost your immune system. Each capsule has the probiotic equivalent of 10 cups of yogurt and is dairy-free, sugar-free, and gluten-free. This container comes with 30 pills to be taken just once a day (most recommend taking it at night, especially when you’re just starting on probiotics).
That said, supplements with higher numbers of CFUs are sometimes used to treat conditions such as irritable bowel syndrome (IBS), allergies, and respiratory illness. While probiotics have generally been found to be safe for most people with normal immune systems, too much can cause gas and upset stomach. We narrowed our search to supplements with dosages between 1 billion and 100 billion CFUs.
Like some of the other probiotics we’ve reviewed, the HyperBiotics PRO-Women Probiotics with Cranberry Extract and D-Mannose do not need to be refrigerated in between uses. What sets this particular formula apart though is its longer shelf life made possible by the patented HyperBiotics ‘LiveBac’ manufacturing process. In fact, the HyperBiotics PRO-Women Probiotics formula can usually last for more than a year when stored in normal indoor conditions!

Some yogurts contain the aforementioned bacteria; however, because they are sensitive to oxygen, light, and dramatic temperature changes, make sure to look for yogurts with “live and active cultures.” Many commercial yogurts are heat-treated or pasteurized, resulting in the loss of these valuable cultures. Learn more about the smart way to shop for probiotics.
Probiotics produce enzymes that help break down chemicals the average human gut has a hard time with, like the oligosaccharides in legumes. That results in less gastrointestinal distress and better absorption of nutrients. Probiotics also elicit an immune response that helps your body deal with harmful pathogens and other GI problems. The hard research, especially on recommended CFU dosages, is minimal, but it’s expanding as interest in the product does.

The foods that are highest in prebiotic fiber are also difficult to find and prepare. Jerusalem artichoke — not the average artichoke sold in your local grocery store — and chicory root contain the highest amounts of inulin and oligofructose. The good news is that Prebiotin offers an easy solution: with our simple supplement, you can get enough prebiotic fiber through normal dietary intake instead of eating a high amount of chicory root a day. Prebiotin is also low in calories. Unlike other fiber supplements, Prebiotin does not have an unpleasant taste or texture. It is slightly sweet and easily combines with beverages such as coffee. You can also sprinkle it on top of food.


Sick of fighting off cold after cold? The Align Daily Immune Support Probiotic Supplement is a great way to give your immune system a boost while protecting your gut bacteria. Align is one of the most popular probiotic brands out there and is trusted by both doctors and nutritionists. The Daily Immune Support has Bifidobacterium lactis BB-12, a probiotic strain thought to be most beneficial to your immune health. It’s a lactic acid bacteria that can also help to fight lactose intolerance. This probiotic contains five billion CFUs (generally, most adults should take at least one billion CFUs in a probiotic) and is meant to be taken once a day.

You also want to look at the guarantee fine print: If the CFU number is guaranteed at time of manufacturing, but not at the time of expiration, you could be taking a less potent dose of probiotics than you think because potency fades over time. I made this mistake when I was traveling once and went to the grocery store to pick up probiotics. On the bottle label it said guaranteed at 20 billion CFU at the time of manufacturing. This doesn’t tell you the CFU for when I was actually taking the probiotics. For instance, our probiotics are manufactured at 60 billion and 200 billion CFU, and guaranteed at 30 billion and 100 billion CFU, respectively, at time of expiration.
There’s hard science saying probiotics can help with certain kinds of diarrhea, but for other conditions, it’s a bit of a crapshoot (har har). Lebwohl says that one of the first things that needs to change for probiotics to go widespread legit in the medical community is their regulation. Since they’re currently marketed as dietary supplements, they’re not subjected to the same FDA standards that medications are. That means that not only have they not been proven to work, it also means there’s also no assurance that what’s on the labels of these products actually matches what’s inside the bottle.
Most people with diverticulosis have few if any symptoms at all. When people do experience signs and symptoms of diverticulosis (diverticular disease) they may include abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon. Treatment methods for diverticulitis includes prescription medications, and in some cases, diverticulitis surgery.
Both probiotics and prebiotics are a continuing topic of research regarding immunity. When used in conjunction, scientists refer to them collectively as synbiotics. One 2015 review on the subject stated, “We suggest that LAB and Bifidobacteria and novel strains [of probiotics] might be an additional or supplementary therapy and may have potential for preventing wide scope of immunity-related diseases due anti-inflammatory effect.”
If you've tried a probiotic after following these steps and it doesn't seem to be working for you (or you just want some extra guidance in choosing one), head to your doctor (or a dietitian) to get a recommendation. "Have a thorough discussion with your doctor to make sure you are taking the appropriate bacterial strain for the appropriate reason," advises Dr. Ivanina. "Then, follow up after taking the probiotic to make sure it is having the intended effect."

Twenty-one volunteers were given a course of antibiotics and then split into three groups. The first group were left to let the microbiome recover without any interventions, the second group were given probiotics and the third were given a fecal transplant of their own gut bacteria which was collected before the antibiotic treatment. The study found that the probiotics easily colonized the gut of the second group, but worryingly, rather than aiding the return of the normal gut microbiome, the probiotics actually significantly delayed it for months compared to both the group that had no intervention and the people who received a transplant of their own gut bacteria. 

"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."
You may have heard some questions over whether SBOs are safe: The NIH has a presumed case report, which hasn’t been 100 percent verified, of someone with Lymphoma getting septicemia from taking a SBO (the organism B. subtilis). Some say that if you have leaky gut, you should heal it before supplementing with SBOs. If you are immunocompromised or have cancer, you can consult with a physician first to be safe.
In the gastrointestinal tract L. Plantarum can help regulate immunity and control inflammation. A 2007 study found that the probiotic could suppress an inflammatory response in the gut. Perhaps most significantly, a double blind placebo-controlled study over 4 weeks concluded that L. Plantarum 299v provided effective symptom relief, especially of abdominal pain and bloating, in patients with Irritable Bowel Syndrome [1].
Most people with diverticulosis have few if any symptoms at all. When people do experience signs and symptoms of diverticulosis (diverticular disease) they may include abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon. Treatment methods for diverticulitis includes prescription medications, and in some cases, diverticulitis surgery.
Many studies have shown that probiotics reduce diarrhea associated with taking antibiotics in both adults and children. In fact, it is common for physicians and pharmacists to recommend eating a probiotic-fortified yogurt every day during a course of antibiotics to prevent diarrhea. More research is needed to determine which probiotics are associated with the greatest effect for specific antibiotics.
Both probiotics and prebiotics are a continuing topic of research regarding immunity. When used in conjunction, scientists refer to them collectively as synbiotics. One 2015 review on the subject stated, “We suggest that LAB and Bifidobacteria and novel strains [of probiotics] might be an additional or supplementary therapy and may have potential for preventing wide scope of immunity-related diseases due anti-inflammatory effect.”
Dermatologist Dendy Engelman, MD, also points out the key role probiotics play in gut health and your body's immune system. "Probiotics are live microorganisms that may be able to help prevent and treat some illnesses," explains Engelman. "Probiotics can create 'holes' in bad bacteria and kill them. Similar to the way antibiotics work in the treatment of acne and rosacea, probiotics can help fight harmful bugs from triggering inflammation. In patients with acne and rosacea, living microorganisms on the skin are recognized as foreign by the body's immune system. The immune system springs into action to counter this potential threat resulting in the inflammation, redness, or bumps common in these skin conditions."
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.

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.


Probiotic supplements and foods can play a major positive role in brain fog. Lactobacillus, in particular, can produce neurotransmitters used for brain neuron-to-neuron transmission to facilitate thinking. Probiotics can interact with the vagus nerve to the brain, with the enteric nervous system that can communicate with the brain, and with the brain via chemical messengers.
The scientists discovered that the probiotics successfully colonized the GI tracts of some people, called the "persisters," while the gut microbiomes of "resisters" expelled them. Moreover, the persister and resister patterns would determine whether probiotics, in a given person, would impact their indigenous microbiome and human gene expression. The researchers could predict whether a person would be a persister or resister just by examining their baseline microbiome and gut gene expression profile.
Survival past stomach acids - probiotic powder in capsule form is ill prepared when it comes to protecting the delicate bacteria from being pulverized by the harsh environment of the stomach acids. Worse, most of the organisms tend to die off before they reach their intended destination due to moisture that gets trapped between the capsule shell and the powder.
Dr. Michelle Schoffro Cook says there’s no single best strain of bacteria, though some strains, like L. Acidophilus or B. Bacterium, have wide-reaching effects. They often act as a starting point from which to add other strains with more specific impacts. Already have probiotics on hand or want to arm yourself with raw knowledge before you shop? The table below shows the research- and expert-backed strains we looked for in each use case:

Renew Life offers a powerful, high potency blend of 10 specially selected Lactobacillus and Bifidobacterium strains designed to help restore your body’s good, natural ora. Their probiotics come in a special capsule designed to survive stomach acid and make it intact into the intestines to deliver the probiotics more effectively where they are most needed.


EDITOR’S CHOICE: As the only probiotic formula we reviewed backed by a New York Times Bestselling author and expert in the human biome, the Garden of Life Dr. Formulated Once Daily Women’s Probiotic is our top choice for overall digestive and women’s health. With 50 billion cultures and 16 probiotic strains, this probiotic helps to promote women’s digestive, immune and vaginal health.
You dread stepping on the scale and avoid looking at your profile in the mirror because you know you gained weight and need to lose some. You tried every diet on the market to no avail. Your frustration level is high, but you do not need to give up hope. The first thing to do is to love yourself regardless of your weight so that your emotions and stress levels do not sabotage your efforts. You can love yourself while working toward self-improvement.
If you’re most interested in taking a probiotic supplement for overall gut health, I suggest starting with 30 to 50 billion CFUs. Take probiotics on an empty stomach once or twice a day for at least three months. After that time, reassess and decide if the benefits warrant continuing a maintenance dose of the probiotic supplement. However, if you have SIBO, beware of starting a probiotic too soon after your treatment. In this case, it’s best to work with a health practitioner on which probiotic is right for each stage of the treatment.
This makes it harder for your immune system to work properly and leaves you open to feeling under the weather unnecessarily. The good news is that taking probiotics can help replenish your gut microbiome, and since 80% of your immune system is in your gut, this inevitably has a very supportive effect on your immunity. Probiotics also specifically support your mucosal immune systems, found in your ear, nose, and throat area and your lungs, helping you to maintain respiratory health.4
Some people prefer probiotic supplements over foods, but Dr. Cresci notes that probiotic foods are a better choice. In particular, fermented foods — like yogurt, kefir (a yogurt-like beverage), kombucha (fermented black tea), sauerkraut (refrigerated, not shelf-stable), kimchi (made from fermented cabbage) and tempeh and miso (made from fermented soybeans) — provide a nourishing environment in which healthful bacteria thrive and release an important byproduct: short-chain fatty acids.

After suffering from liquid nighttime but painless diarrhea for over a year (which I semi-controlled with one Imodium/day), I had a colonoscopy that gave a diagnosis of microcolitis. After the colonoscopy, I developed for the first time excrutiatingly painful gas pain in the LLQ. Usually this pain started during aerobic activity such as walking, but not always. Sometimes I woke up with it. CT scan revealed nothing. Will a probiotic help and if so, which would be best? There are so many it is hard to choose.
The root of the word probiotic comes from the Greek word pro, meaning "promoting," and biotic, meaning "life." The discovery of probiotics came about in the early 20th century, when Elie Metchnikoff, known as the "father of probiotics," had observed that rural dwellers in Bulgaria lived to very old ages despite extreme poverty and harsh climate. He theorized that health could be enhanced and senility delayed by manipulating the intestinal microbiome with host-friendly bacteria found in sour milk. Since then, research has continued to support his findings along with suggesting even more benefits.
Back to the question of what are probiotics: There are five main types, each in its own classification called a genus. Within each genus there are multiple species, and within those species there are multiple strains. For example, Lactobacillus is a very common genus of probiotics. Within that genus are numerous species, such as rhamnosus. The genus and species of a microbe are always italicized, making it easy to know that a microbe is involved. In a species such as Lactobacillus rhamnosus (often abbreviated L. rhamnosus), there are many strains. An example of the name of a strain is L. rhamnosus GR-1.

The Golive Berry Probiotic and Prebiotic Supplement Blend is perfect for tossing in your bag or keeping in your desk. Each packet includes 15 billion CFUs and 15 different probiotic strains. It also has a soluble fiber prebiotic to promote the growth of good bacteria in your body. Each packet contains 30 calories and comes in five flavors including pomegranate, melon cucumber, citrus blueberry, and a flavorless option. It can be mixed in any hot or cold drink, but we recommend tossing the flavored packet into a bottle of water. You’ll get 10 packets in each order.
We are clearly getting to the strain level by going beyond “Saccharomyces boulardii” and to “Saccharomyces boulardii CNCM I-745”. They did a great job by actually putting it on the label so you don’t even have to contact the company to see exactly what strain you’re getting. (P.S. this is a well-researched strain that I highly recommend, especially for preventing antibiotic-associated diarrhea.)
×