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."

According to a 2014 meta-analysis, probiotics benefit diabetics by improving insulin sensitivity and decreasing the autoimmune response found in diabetes. The authors suggest that the results were significant enough to conduct large, randomized, controlled trials (the “gold standard” of scientific studies) to find if probiotics may actually be used to prevent or manage diabetes symptoms. Combining probiotics with prebiotics may also help manage blood sugar, particularly when blood sugar levels are already elevated. (87)
Cleaning up your diet to remove things that bother you and to add nutrients you and your microbiota need, physical activity to reduce stress and increase feel-good neurotransmitters, mindfulness to discover how your thoughts affect your feelings, and daily consumption of probiotic pills and foods are easy ways to improve your mental health outlook.
Women’s health expert Dr. Amy Myers is a goop-trusted authority on subjects from autoimmunity and Candida to thyroid dysfunction; and she’ll be speaking IRL at our first wellness summit on June 10. Here, Myers helps us evaluate the increasing buzz around probiotics, and outlines the ins and outs of selecting a particular supplement (whether hers or other brands). Plus, we’ve rounded up our probiotic essentials, from inner beauty powders to favorite fermentation recipes, in one guide:
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.
This story has played out before, most notably with vitamin supplements, which decades of research have revealed to be completely unnecessary for most adults and, in some cases, dangerous, correlating with higher rates of lung, breast and prostate cancers. But that has not stopped marketers from pushing another nutritional craze. According to a National Institutes of Health survey, the number of adults in the U.S. taking probiotics or their cousins, prebiotics (typically nondigestible fibers that favor the development of gut bacteria), more than quadrupled between 2007 and 2012, from 865,000 people to nearly four million. San Francisco–based business consulting firm Grand View Research estimates that the global probiotics market exceeded $35 billion in 2015 and predicts that it will reach $66 billion by 2024.
Because poor gut health is related to autoimmune responses like those found in rheumatoid arthritis (RA), probiotics have been a proposed treatment option for the condition. Only a few studies have been conducted in humans, and only one testing L. casei 01, a particular probiotic strain, was able to find a decrease in RA inflammation and progression of the disease.
The first major finding was that many people were essentially resistant to any effect from probiotics and their gut microbiome did not change after taking them.  Of 19 people in the study taking probiotics consisting of 11 of the most commonly found strains, only 8 had any notable colonization of their gut with the bacteria in the probiotics, with 3 people considered to have significant colonization and 5 people with "mild" colonization.
The second Elinav study, “Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT” involved a mouse model and human patients. One cohort of mice and a parallel human group was given the same probiotic strain used in the first study to see if they had more success repopulating their gut microbiota after a round of antibiotics. Another “watch-and-wait” cohort didn’t take probiotics to assist gut microbiome recovery after antibiotic-related depletion. A third cohort was given an “autologous fecal microbiome transplant” (aFMT) which consisted of a patient’s own gut microbiota that had been collected before he or she started a cycle of antibiotics.
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.
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.
Cleaning up your diet to remove things that bother you and to add nutrients you and your microbiota need, physical activity to reduce stress and increase feel-good neurotransmitters, mindfulness to discover how your thoughts affect your feelings, and daily consumption of probiotic pills and foods are easy ways to improve your mental health outlook.

If you decide to use a probiotic supplement and get clearance from your doctor for doing so, be sure to read the label carefully. You want to be sure that the supplement contains live strains of the bacteria or yeast, and that the life of these strains is guaranteed at the time of use, and not at the time of manufacture. Other points of comparison are the number of bacteria strains and the number of colony-forming units, although this does not necessarily guarantee results.


It has been suggested that probiotics be used to treat problems in the stomach and intestines. But only certain types of bacteria or yeast (called strains) have been shown to work in the digestive tract. It still needs to be proved which probiotics (alone or in combination) work to treat diseases. At this point, even the strains of probiotics that have been proved to work for a specific disease are not widely available. 

"This suggests that probiotics should not be universally given as a 'one-size-fits-all' supplement," study co-senior author Eran Elinav, an immunologist at the Weizmann Institute of Science in Israel, said in a statement. However, it may be possible to tailor probiotic treatments to the individual, based on the types of microbes already in his or her gut, as well as other factors, so that he or she gets the most benefit from probiotics, the researchers said. 

Whether a brand of probiotics works really depends on its quality and your body's own gut. Everyone has a different set of gut flora so try several to see what works for you. Using a brand of at least 40 billion CFU is best. There seems to be some debate as to whether one should use refrigerated or unrefrigerated probiotics. I went with the side that claims unrefrigerated are sturdier and less prone to die off.


B. Bifidum has also been shown to prevent intestinal pathogens or digestive disrupters from flourishing in the gut, essential in restoring the bacterial balance and optimizing digestion. Clinical research found it supports a significant reduction in IBS symptoms, an improvement in quality of life and even helps relieve occurrences of ulcerative colitis – a chronic inflammatory bowel disease. [1].
Probiotics are found in everything from chocolate and pickles to hand lotion and baby formula, and millions of people buy probiotic supplements to boost digestive health. But new research suggests they might not be as effective as we think. Through a series of experiments looking inside the human gut, researchers show that many people's digestive tracts prevent standard probiotics from successfully colonizing them. Furthermore, taking probiotics to counterbalance antibiotics could delay the return of normal gut bacteria and gut gene expression to their naïve state. The research publishes as two back-to-back papers on September 6 in the journal Cell.
The side effects of antibiotic use are often not trivial. Many people experience discomfort and a change in bowel habits, but some experience more severe infections, such as opportunistic colonization of the gut with bacteria such as Clostridium difficile (C.diff), which affected half a million Americans in 2015 and was directly responsible for at least 15,000 deaths.
If you go with a supplement, know that the FDA regulates these products but treats them like foods and not medications. Unlike drug manufacturers, supplement makers don’t have to show their products are safe or effective to sell them. That means that these firms are in charge of checking the safety and labeling of their products before they sell them to make sure they meet FDA rules.
Probiotics are “friendly” bacteria that inhabit your body. Sound strange? These microscopic roommates can be your best buds if you show them a little love. One surefire way to do that is with probiotic supplements. Probiotics support the right ratio of good to bad bacteria in your gut. For bonus points, call on digestive enzymes. These unique blends offer specific nutritional support to assist digestion and nutrient absorption. Your healthy body will quickly appreciate these lifelong friends.
Best Probiotic chose iFlora Multi-Probiotic by Sedona Labs as one of the best probiotic supplements. It is a blend that works well in both the large and small intestines and it can survive stomach acid to maintain effectiveness. According to Sedona Labs’ website, iFlora delivers 32 billion active cells through 16 probiotic strains, plus probiotic fiber.

"I recommend supplementing with the species lactobacillus and bifidobacterium, and there are different strains within those species that are each beneficial. Garden of Life and Align probiotics contain bacteria that help the gut microbiome and maintain digestive balance, and 1MD's Complete Probiotics Platinum is one of the best probiotics with over 50 billion live cultures that help with gut and digestive health."

According to the NIH, probiotic supplements contain many microorganisms that are the same as or similar to the ones that naturally live in your body, but there's still a lot of research to be done on probiotics and how they work. It's important to keep in mind that not all probiotics have the same effects and that taking probiotics isn't a guarantee of better health. And while they're generally safe for healthy people to take, with side effects being limited to mild digestive discomfort, they could interact with certain medications or pose health risks to people with underlying medical problems — that's why it's smart to talk to your doctor before getting started with a supplement.
Next the researchers measured what happens to the microbiome of people who take probiotics in the hope of restoring their microbiome after antibiotics. Twenty-one volunteers took an identical course of antibiotics and were then assigned to one of three groups. The microbiome of the first group was allowed to recover by itself, whereas the second group was given probiotics. The third group was treated with a dose of their own original pre-antibiotic microbiome by a faecal microbiota transplant (FMT).
Even if you’re not sensitive to dairy, though, probiotics that require refrigeration can be inconvenient; but there are now some that don’t need to be kept cold. For example, our probiotics are sealed in nitrogen blister packs to protect them from heat, as well as moisture and oxygen because the air can’t get in. Look for probiotics that are individually packed to protect the live cultures. If they just come in a bottle they could be losing potency from air getting in.
The beneficial microbes, including probiotics, live with other microbes that are either benign, pathogenic (disease-causing), or opportunistic, meaning that they normally play nicely but can get out of control if given the opportunity. Actually, any microbe can cause you problems if it ends up in a place other than where it is supposed to be. Such a scenario can happen with intestinal permeability, commonly called leaky gut. Leaky gut happens when the layer of skin-like cells in your GI tract develops gaps in between the cells, allowing food particles, toxins, microbes, and other hazards to enter your bloodstream, if not stopped by the immune system. Since mucus, the thin layer of cells, and your immune system are your only defenses against the outside world within your digestive tract, it is very beneficial to you to have helpful microbes protecting you from potentially pathogenic microbes. These beneficial microbes can produce acids or antimicrobial products called bacteriocins, which hinder or kill pathogens. They can also stand in solidarity to prevent pathogens from taking up residence, or displace them if they do.
Bacteria in your digestive tract can be good or bad, according to the website Best Probiotic. It quotes the Royal Academy of Medicine England as blaming an imbalance between good and bad bacteria for causing 80 percent of all degenerative diseases. Probiotic supplements with "good" bacteria have become increasingly popular. They can aid the immune system, digestion and vitamin absorption, as well as prevent diarrhea and irritable bowel syndrome. The website Women to Women recommends probiotics that combine saccharomyces, lactobacillus acidophilus and bifidobacteria in the billions. MayoClinic.com also recommends lactobacillus and advises looking for products that contain live, active cultures. You should always check with your doctor before adding any supplements to your diet.
Reviews looking at the treatment or prevention of vulvovaginal candidiasis in women, pneumonia in patients hooked up to respirators, and colds in otherwise healthy people show some positive results. But the authors note that the studies are almost all of low quality, small in size, and often funded by companies with significant conflicts of interest.

Because of the way bacteria spread from the rectum to the vagina and urinary tract in women, probiotics have been a proposed remedy for urinary tract infection (UTI) in women. A 2012 review confirmed that probiotics seem to be effective in preventing recurrent UTIs, but more research is required before a determination can be made. The healthy strains of bacteria that help achieve this are also somewhat less common, which means proper treatment could be logistically complicated.

Probiotic therapy may also help people with Crohn's disease and irritable bowel syndrome. Clinical trial results are mixed, but several small studies suggest that certain probiotics may help maintain remission of ulcerative colitis and prevent relapse of Crohn's disease and the recurrence of pouchitis (a complication of surgery to treat ulcerative colitis). Because these disorders are so frustrating to treat, many people are giving probiotics a try before all the evidence is in for the particular strains they're using. More research is needed to find out which strains work best for what conditions.
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.
After further analyzing the data, the researchers found that they could predict whether the probiotics would take hold in people's guts by examining their microbiome and gene expression in the gut taken at the start of the study. However, this prediction method needs to be confirmed in future studies. The researchers called for further research to better understand why some people resist colonization by probiotics, as that future research may enable researchers to counteract the resistance.

Remember that dietary supplements are not tested by the U.S. Food and Drug Administration like medications. And the probiotic strains in the supplements may not be specific for the condition you're looking to treat. You may want to consult with a practitioner, like a registered dietitian, who is familiar with probiotics. Always tell your physician what you are doing that may affect your health.
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.
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.
They can break down substances in foods that keep you from absorbing the micronutrients inside. They not only protect against the consequences of rogue molecules passing through a leaky gut, but they assist your intestinal cells in staying healthy to optimize nutrient absorption. In addition, some of the metabolic by-products of probiotics, such as short-chain fatty acids and vitamin production, are very nourishing to your GI tract.

Digestive tract conditions. Probiotic supplements may be useful in treating and preventing inflammatory conditions, such as pouchitis (which affects people who have their colons removed), inflammatory bowel diseases (such as ulcerative colitis and Crohn's disease), and chronic stomach inflammation and ulcers caused by Helicobacter pylori bacterium. They may also be helpful in treating constipation, irritable bowel syndrome, acid reflux, spastic colon; shortening the duration of infectious diarrhea; and reducing the recurrence of bladder and colorectal cancer. Some studies suggest that yogurt is helpful in preventing diarrhea - a common side effect of treatment with antibiotics. It has also been shown to prevent or treat urinary tract infections and vaginal yeast infections in women.
In addition to the prophylactic effect of stocking your gut with good bacteria, there are some probiotic strains that have also shown promise in treating symptoms of autoimmune disorders, including L. Paracasei and L. Acidophilus. Others, like B. Lactis, could help prevent respiratory infections. Renew Life Flora Extra Care has all three targeted bacteria strains at 30 billion CFUs per serving.
Taking relatively high doses of these probiotic strains before, during, and after antibiotic treatment can help your microbiome get back on its feet: B. Lactis, B. Infantis, L. Acidophilus, L. Casei, L. Bulgaricus, L. Paracasei, L. Rhamnosus GG, and S. Boulardii. Our antibiotic combatant MegaFood MegaFlora has six of these strains, as well as eight others. One serving contains 20 billion CFUs to replenish the good bacteria.
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.
Other uses. Many other claims are made for probiotics—that they lower cholesterol, alleviate allergic skin conditions (like eczema), treat ulcers and urinary tract infections, improve vaginal health, reduce the risk of colon cancer, ease anxiety and depression, and ward off traveler’s diarrhea. Good evidence to support these claims is lacking. Research on probiotics for weight loss has yielded inconsistent results, and even studies with positive results have mostly found very small benefits, as was seen in an analysis of 15 clinical trials in Obesity Reviews in 2018.

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."
Yes! Beneficial yeast is a probiotic, defined as a microorganism that supports human wellness. (Probiotic means “for life.”) Saccharomyces boulardii is a remarkable yeast that can significantly support your whole internal ecosystem. It helps reduce problematic yeasts, such as Candida, and replenishes healthy gut flora.* While many probiotic supplements only deliver friendly bacteria without yeast, Probiotic All-Flora contains 5 billion CFU of beneficial yeast for complete support.

Lebwohl says IBS isn’t just about intestinal distress. For many IBS sufferers, it’s about the way our brain receives messages about pain. He describes the human colon as “almost reptilian” in the way that it contracts and relaxes throughout the day, but says these contractions are usually happening way below our threshold of consciousness, so we don’t even notice. In people with IBS, the neurotransmitters in our gut (yes, we have them in there too) may be sending severe distress signals to the brain about benign contractions happening in digestive tract.

"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 said in a statement. "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." Segal added, "This opens the door to diagnostics that would take us from an empiric universal consumption of probiotics, which appears useless in many cases, to one that is tailored to the individual and can be prescribed to different individuals based on their baseline features."
Quality matters for any supplement, and that goes triple for probiotics. Many commercial brands lack the technology to identify specific strains and how much of that strain each dose contains. That could mean you get an ineffective or potentially harmful dose. It's a great sign if the company is using strains that have been used specifically in clinical trials at a dose similar to or the same as that used in the study. This is one of the only ways to guarantee a probiotic's clinical effectiveness.

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.


But before you start reaching for the calcium supplements, there may be a more effective way to support your bone health. Like many other parts of the body, the health of your bones is closely tied to the health of your gut, especially your intestines. Temporary intestinal inflammation can trigger an immune response in which your body releases interleukins, proteins that have an immune function but also absorb bone tissue. If the temporary inflammation remains unaddressed, these molecules can take a toll on your bones, eventually weakening them.14

What's more, there's still a lot more to learn about the microbiome and probiotics, in general. "Truth be told, the research area of probiotics and health is still pretty much in its infancy," says registered dietitian Kate Scarlata. Research is growing in the area of gut microbiome daily—but it is much more complicated than first thought." With all these options and major gaps in the available information, where are you supposed to start? Here, gut experts narrow it down to three simple tips for picking the right probiotic for you.
Suez and colleagues investigated the recovery of the gut microbiota after antibiotic treatment and found that probiotics might perturb rather than aid this process. The probiotics rapidly colonised the gut but prevented the normal microbiota from repopulating for up to 5 months. While likely to be considerably less appealing, the group who received autologous faecal microbiota transplantation recovered their microbiota the quickest, with the composition of the microbiota returning to normal within days. Furthermore, Zmora and colleagues showed that colonisation occurred in highly individualised patterns, with some people's gastrointestinal tracts rejecting probiotics and others allowing colonisation by the probiotic strain, meaning that many individuals taking probiotic supplements are simply wasting their money.

​​​​​​AZO Complete Feminine BalanceTM is a daily probiotic supplement designed for the unique needs of women. Researchers that formulated the blend started by selecting species that are dominant in the healthy vaginal microbiota. Then they further refined the formula by selecting strains of probiotics that flourish in the vagina. The blend is clinically proven to help protect vaginal/feminine health.*

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