Because there's a huge variety of probiotic products available on the market, many people struggle to find the right one for them. "There are many different strains of bacteria in different combinations within different probiotic supplements," explains Brooke Scheller, a clinical and functional nutritionist. "For example, a probiotic may contain a single strain of bacteria or many. It may also contain other vitamins, minerals, or other ingredients that may tout health benefits," she says. There are many different dosages, delivery systems (powder, tablets, capsules), and formulations (refrigerated vs. shelf-stable), and some probiotics also contain prebiotics, which basically act as fertilizer for the probiotics. (Related: Why Your Probiotic Needs a Prebiotic Partner)

The gut microbiota has been implicated in diseases ranging from obesity to Parkinson's disease and depression. Little wonder then that commercial probiotics have gained widespread popularity and are now estimated to command a US$37 billion market worldwide. But with research into the microbiome still in its infancy, increasing evidence suggests that both commercial and clinical use of probiotics is outpacing the science.
As a world-renowned neurologist and nutritionist, Dr. David Perlmutter has become somewhat of a household name when it comes to the linkage between what we eat and how we feel. He is known as “The Empowering Neurologist” and has been featured on the Doctor Oz Show, CNN, and NPR as well as in prominent publications like The New York Times, Forbes, Time Magazine, and the Wall Street Journal. If that wasn’t enough to spark your interest, Dr. Perlmutter is also the award-winning author of the Grain Brain Whole Life Plan, Brain Maker, and Grain Brain, all of which have become international bestsellers.
Renew Life Ultimate Flora offers 30 billion CFUs with 10 scientifically studied strains of Bifidobacterium and Lactobacillus, which according to current scientific research, are the two most prevalent good bacteria found in a healthy gut. In other words, you might choose these if you’re seeking a careful balance designed to re-establish proper immune health and digestive equilibrium.
Notably, after someone was tagged a “persister” or “resister” clear patterns emerged on how probiotics would impact his or her indigenous microbiome and gut bacteria profile. "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," Eran Segal said in a statement. "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."
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.
Bifidobacteria is a family of bacteria that has been studied for its ability to prevent and treat various gastrointestinal disorders, including infections, irritable bowel syndrome and constipation. In addition to making lactic acid, it also makes some important short-chain fatty acids that are then absorbed and metabolized by the body. There is also some experimental evidence that certain bifidobacteria may actually protect the host from carcinogenic activity of other intestinal flora.
These are live microorganisms that will not provide the promised benefits if they don't remain alive. The manufacturer and consumer must pay close attention to the conditions of storage at which the particular microorganism will survive and the end of their shelf life. The potency will indicate the number of viable bacteria per dose, and the purity has to do with presence of contaminating or ineffective bacteria.
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.
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.”
The research also showed that while probiotics colonised the gastrointestinal tract of some people, the gut microbiome of others just expelled them. There was no way of telling from their stool sample which category people fell into. “Some people accept probiotics in their gut, while others just pass them from one end to the other,” says Elinav. They found that the probiotic colonisation patterns were highly dependent on the individual. That tells us that the concept that everyone can benefit from a universal probiotic bought from the supermarket is empirically wrong, he says.
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.
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.
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.
That’s why adding probiotics and prebiotics to your diet provide the best possible outcome from a bacterial perspective. It isn’t always easy to eat naturally prebiotic-enriched foods, however, because they are often distasteful to eat in quantity. Would you enjoy eating several cups of raw onion or garlic every day? Probably not. Other foods that contain prebiotic fiber, such as bread and bananas, are high in calories. Consuming hundreds of calories of these foods every day is counterproductive if you’re trying to lose weight.
Most probiotics designed for women are designed to target feminine health conditions like yeast infections and urinary tract infections OR overall digestive health. While this may not be a concern for some women, the fact is that most of us can benefit from probiotics that keep our reproductive systems in check while also promoting overall digestive and immune health. That’s why we love the Culturelle Women’s Healthy Balance Probiotic: this women’s probiotic was specially designed to maintain feminine health without sacrificing the digestive and immune support of traditional probiotics!
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].

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.

Lactobacillus predominantly live in your small bowel (the portion of your gut that follows the stomach). Probiotics containing Lactobacillus sp. help to repopulate the small intestine with friendly organisms that aid in supporting digestion and immune function. The most beneficial are L. acidophilus, L. plantarum, and L. paracasei. One study found Lactobacillus acidophilus could reduce gut inflammation. L. rhamnosus helps increase GABA expression (an inhibitory neurotransmitter that helps you feel relaxed) in the brain, resulting in lower anxiety and depression-related behavior. Another found that a combination of Lactobacillus and Bifidobacteria (which we'll talk about next) improved symptoms of bloating in patients with functional bowel disorders, and yet another found that when people took the Lactobacillus rhamnosus GG strain, it significantly reduced the risk for antibiotic-associated diarrhea.


For example, yogurt is made with two “starter” bacterial cultures — Streptococcus thermophilus and Lactobacillus bulgaricus — but these bacteria are often destroyed by your stomach acid and provide no beneficial effect, Dr. Cresci explains. Some companies, though, add extra bacteria into the product, so check the labeling and choose products with bacteria added to the starter cultures, she advises.
Today, most of the Japanese population begins the day with a warm bowl of miso soup, believed to stimulate the digestive system and energize the body. Made from fermented soybeans, rice or barley, adding a tablespoon of miso to some hot water makes an excellent, quick, probiotic-rich soup. The fermentation process can take anywhere from a few days to a couple of years to complete, and the end result is a red, white or dark brown paste with a buttery texture.

There’s good and bad bacteria in there (fascinating fact: an estimated 100 trillion bacteria live inside your digestive tract): When the good outweighs the bad, your immune health soars; when the bad overpowers good, you get sick. You have diarrhea. Your immune system tanks. Your IBS, lactose intolerance, and other gut problems are exacerbated. It throws your entire system out of whack.
Dr. Vincent M. Pedre, medical director of Pedre Integrative Health and president of Dr. Pedre Wellness, is a board-certified internist in private practice in New York City since 2004. His philosophy and practices are a blend of both Western and Eastern medical traditions. He is a clinical instructor in medicine at the Mount Sinai School of Medicine and is certified in yoga and medical acupuncture. His unique methodology is best described as integrative or defined by a functional, systems-based approach to health. With his holistic understanding of both sides of the equation, he can help each patient choose the best course of action for their ailments to provide both immediate and long-term relief. His holistic approach incorporates positive, preventive health and wellness lifestyle choices. Dr. Pedre Wellness is a growing wellness platform offering health-enhancing programs along with informative social media and lifestyle products, such as dietary supplements, books, and weight-loss programs.
Studies have shown some benefits linked to Lactobacillus and treating and/or preventing yeast infections, bacterial vaginosis, urinary tract infection, irritable bowel syndrome, antibiotic-related diarrhea, traveler's diarrhea, diarrhea resulting from Clostridium difficile, treating lactose intolerance, skin disorders (fever blisters, eczema, acne, and canker sores), and prevention of respiratory infections.

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.
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.
Unless you have a perfect gut and are already eating lots of fermented foods—which is rare, although you can work up to this point—it’s difficult to get all the probiotics you need from diet alone. Most of us don’t have perfect guts—everything from antibiotics to high-carbohydrate diets to being born via a C-section can compromise the balance of bacteria in our microbiome. Supplementing with a probiotic can help to restore imbalances, and it’s also just a great preventative health measure, helping to keep your microbiome in balance and your immune system healthy to ward off illnesses.

From upset tummies to the common cold and everything in between, it seems as though the entire world is exclaiming, “there’s a supplement for that!” these days. Call it a symptom of the Aquarian Age, the fact that Amazon recently bought out Whole Foods, or simply that Western society is catching up with what other parts of the world have known for centuries but, for better or worse, everyone seems to be ditching the traditional meds in favor of a more holistic approach to wellness.
"In fact," she continues, "80% of immune system cells are found in the gut. In addition to the well-known GI benefits of minimizing bloat, gas, constipation, and diarrhea, probiotics aid in digestion by extracting nutrients, helping your body absorb minerals, produce vitamins, and make brain chemicals, including over 30 neurotransmitters along with mood-enhancing serotonin. A healthy person has over 100 trillion microbes, generally a five to one ratio of helpful to harmful."
The Bifidobacteria (Bifidus) predominantly live in your colon or large intestine. They produce the very important short-chain fatty acid butyrate, which supplies energy to your colon cells to keep them functioning optimally. But butyrate also gets absorbed by the body, regulating a variety of metabolic processes, including your sensitivity to the hormone insulin (which regulates blood sugar) and even memory formation in the brain. The most beneficial of these are B. lactis and B. longum. Research shows the benefits for Bifidobacteria include reducing inflammatory bowel disease and several cancers, especially colon cancer. Another study showed that a specific strain of Bifidobacterium lactis helped control body fat mass and reduced waist circumference and food intake.
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.
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.
Unfortunately, the U.S. has no federal standards for probiotic supplements. Therefore, you run the risk of purchasing a product without any guarantee that it contains its advertised probiotic strains, that the strains are alive, or that the product is free from unhealthy ingredients. Therefore, it may be best to choose a brand-name probiotic that has research backing their effectiveness. Here are some examples:
Russian microbiologist Elie Metchnikoff (1845-1916) was the first to associate the large amounts of fermented dairy products with the good health and longevity of Bulgarians back in 1907. He proposed that the acid-producing organisms in fermented dairy products could prevent what he called "fouling" in the large intestine. He believed if eaten regularly, these foods could lead to a longer, healthier life. One version of the Old Testament even attributes Abraham's long life — 175 years — to the "consumption of sour milk." Fermented milk products may have also been used to treat illnesses of the digestive tract during Roman times.
Flora offers a high potency blend of eight super strain probiotics for general gut health and immune system support including multiple varieties of Lactobacillus and Bifidobacterium, among others. Containing up to 42 billion CFUs per capsule, this powerful health-boosting blend uses only strains found naturally in the human body, which increases its effectiveness.
Make sure to keep them away from moisture and heat which can kill off some of the microbes. I recommend taking on an empty stomach, ideally right when you wake up. You should always store supplements in a cool, dark place but refrigeration is best. Most of the strains of probiotics are fragile and should be protected from heat- so refrigeration is ideal. I recommend the probiotic Gut Instinct from HUM Nutrition for transparency and high quality.

Pinning down the exact causes of IBS is difficult because each person has his or her own combination of causes. One cause that is receiving much attention is that of a disrupted microbiome, as there is a strong association between having a gastrointestinal (GI) infection, like food poisoning, and the onset of IBS. Also, the FODMAP diet, and nonabsorbable antibiotics to kill gut microbiota, have provided relief in many patients, further supporting the suspicion of a disrupted microbiome as contributing to IBS.

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.


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.
More common than diarrhea is the opposite problem — constipation. In a search for studies on the benefits of probiotics in treating constipation, researchers found that probiotics slowed "gut transit time" by 12.4 hours, increases the number of weekly bowel movements by 1.3, and helped to soften stools, making them easier to pass. But the jury is still out on specific recommendations when it comes to the benefits of probiotics for constipation.

Next time you pack your travel beauty bag, slip a shelf-stable probiotic in there to preempt bathroom emergencies, Fasig says. Look for one that contains Lactobacillus acidophilus, Lactobacillus sporogenes, Bifidophilus bifidum, and Sacchromyces boulardii strains ($20, amazon.com), which Fasig says can improve your intestinal health to fix issues with constipation or diarrhea.
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.∗

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.
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. 

However, a 2003 pilot study and 2011 randomized, controlled trial both reported that RA activities remained unchanged, but the subjects treated with probiotics reported statistically significantly higher levels of “subjective well-being.” One suggested reason for this was that the trials were too short to establish changes in the observable changes in the internal earmarks of RA.
Candida albicans is the most common species that causes yeast infections, but there are others. It is a normal inhabitant of the gastrointestinal tract and is often found in the female vaginal tract. Candida infections on the skin cause red, itchy rashes that often weep moisture, and in the vagina there is often a cottage-cheese-like discharge in addition to the skin symptoms.

There are both probiotics and prebiotics in fermented foods. I differ from a lot of doctors in that I recommend that patients with infections like Candida and SIBO don’t eat prebiotics until they’ve cleared up the infection—because the prebiotics can feed those infections, too. I find that it’s better to get rid of those infections first, and then add in prebiotics to your diet after. [See here for more from Dr. Myers on treating yeast infections.]


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.
Probiotics are clearly incredibly supportive, but they can't do their work alone. To make sure that you're getting the most out of your microbes, it's important that you give them the support they need to work. You've got lots of options for supporting your gut health, from dietary changes to probiotic supplementation, but make sure you're at least covering the following bases.
Niv Zmora, Gili Zilberman-Schapira, Jotham Suez, Uria Mor, Mally Dori-Bachash, Stavros Bashiardes, Eran Kotler, Maya Zur, Dana Regev-Lehavi, Rotem Ben-Zeev Brik, Sara Federici, Yotam Cohen, Raquel Linevsky, Daphna Rothschild, Andreas E. Moor, Shani Ben-Moshe, Alon Harmelin, Shalev Itzkovitz, Nitsan Maharshak, Oren Shibolet, Hagit Shapiro, Meirav Pevsner-Fischer, Itai Sharon, Zamir Halpern, Eran Segal, Eran Elinav. "Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features." Cell (First published: September 6, 2018) DOI: 10.1016/j.cell.2018.08.041
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.
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