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?


Selecting a multi-strain probiotic is also consistent with the theory that filling your gut with enough good bacteria outcompetes any bad bacteria for the same space and resources. In your gut, the more diversified the good bacteria, the harder it is for the baddies to gain a foothold. With all this in mind, we only looked at supplements containing multiple strains of bacteria.

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.
We’ll start with the headliner: the BIO-tract peral, which packs the equivalent of 75 billion CFUs into one tiny, filler-free, 5-billion CFUs pearl. The trick is in protecting those 5 billion CFUs over an 8 to 10-hour period, so they bypass your acidic stomach and reach your intestinal tract, alive and well, allowing you to experience the full and multitudinous benefits of plentiful and beneficial gut bacteria.
Common ailments like stomach upset, allergies, and inexplicable pain seem to be at an all-time high. You may be surprised to learn that the solution to many of you and your family’s everyday woes can be found right in your gut. No, we’re not talking about your intuition or those gut feelings you get on a weird first date, but instead, the millions of tiny bacteria that live in your digestive system. These micro-organisms, or cultures as we in the supplement biz’ like to refer to them as, help keep things moving (if you know what we mean) and can have added benefits for women of all ages!
Better Health Review ranks Ultimate Flora as the most effective probiotic supplement. It contains 30 billion active bifidobacteria for colon health, and 20 billion lactobacilli and lactococcus cultures for the small intestine. According to Better Health Review, it contains all natural ingredients. It earns a perfect 5 score from Better Health Review, and the magazine “Vitamin Retailer” voted it best two years in a row.
Made from aged, fermented soybeans, this paste is brimming with probiotics. You can buy miso paste in a bunch of varieties (white, yellow, red, brown) and the darker the color, the deeper the taste. Miso is a great way to add a burst of earthy, savory flavor for few calories (only 25 to 30 per tablespoon), plus protein, fiber, and bone-strengthening vitamin K, says Sharon Palmer, RDN, author of Plant-Powered for Life. "While we need more research about how these types of fermented foods contribute to health, it's a good idea to introduce more of them into your diet," she says. Use miso to glaze fish or chicken before cooking, mix into a stir-fry recipe, or add to liquid to make a miso broth. One caveat: Miso is very high in sodium. One teaspoon, enough to make a cup of miso soup, has 473 mg of sodium, 21% of the daily recommended limit and 32% of the daily limit for those with high blood pressure.
Third-party testing: Lastly, it's important to remember that probiotics are an unregulated supplement. "Find out whether there is third-party data verifying the potency, purity, and effectiveness of the product," suggests Dena Norton, a registered dietitian and holistic nutrition coach. "Remember that dietary supplements aren't regulated, so you can't necessarily just trust the claims on the label." Check out AEProbio, a site that has compiled research on specific brands of probiotics available in the U.S., recommends Scarlata, and an NSF seal is always a good marker to look for.
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.)
The U.S. Clinical Guide to Probiotic Products1, Canadian Guide to Probiotic Supplements2 and the WGO Global Guidelines for Probiotics and Prebiotics3 provide suggested effective amounts of specific strains for treating certain health conditions, such as constipation or IBS. All 37 products listed the species of bacteria they contained, but only 14 listed amounts of individual strains. We found that 9 of those 14 products provided beneficial bacteria at effective levels. The Center for Responsible Nutrition recommends4 the industry move toward specifying strains as a best-practice because whether a product works and for what purpose depends on its strains.
Although these capsules are more expensive than other options on the market, if you suffer from ulcerative colitis, irritable bowel syndrome, or pouchitis, this probiotic will help manage your symptoms. VSL contains eight different probiotic strains (and more good bacteria than other brands) to alleviate symptoms such as bloating, cramping, and diarrhea. There are 60 capsules per bottle.
Ultimate Flora tested significantly higher than the majority of general probiotic blends. Critical Care is composed of very well-documented probiotic strains and is an effective addition to any lifestyle, capable of conferring a wide variety of health benefits. The probiotic strains are not only diverse, they were also resilient to outside influences and, in many cases, were successful in establishing colonies within the digestive tracts of study participants.
For Irritable Bowel Syndrome, patients who respond to a probiotic might take that in the long term, Lebwohl says, so as to maintain symptom control. With something like antibiotic-related diarrhea, you'd take it for a defined period of time until symptoms are gone. "This has been studied in children and adults and while study results have varied, meta-analyses suggest that probiotics can be protective in this context," he adds.
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.
Eating more foods that are naturally rich in probiotics, like yogurt, kimchi and kefir, can help restore balance in your gut and create more “good” bacteria to fight off inflammation from “bad” bacteria. But what about food products that have probiotics infused into them? Indeed, manufacturers are banking on a new crop of gut-friendly products. From chocolates and granola bars to juices and tonics, nut butters, bottled water and even air sprays, you can’t escape the probiotic movement. 

Similar to yogurt, this fermented dairy product is a unique combination of milk and fermented kefir grains. Kefir has been consumed for well over 3,000 years, and the term kefir was started in Russia and Turkey and means “feeling good.” It is created by the fermentation of milk by the bacteria, and yeasts in kefir starter break down lactose in the milk — that’s why kefir may be suitable for those who are otherwise lactose-intolerant.
Supplements: dietary probiotic supplements -- which are available in capsules, tablets, powders and liquid extracts -- each contain a specific type of probiotic. These products are available at health food and natural food stores, vitamin shops, and other stores. As an example, one commonly used supplement is acidophilus, which is available from several supplement manufacturers.

A closer look at the science underlying microbe-based treatments, however, shows that most of the health claims for probiotics are pure hype. The majority of studies to date have failed to reveal any benefits in individuals who are already healthy. The bacteria seem to help only those people suffering from a few specific intestinal disorders. “There is no evidence to suggest that people with normal gastrointestinal tracts can benefit from taking probiotics,” says Matthew Ciorba, a gastroenterologist at Washington University in St. Louis. “If you're not in any distress, I would not recommend them.” Emma Allen-Vercoe, a microbiologist at the University of Guelph in Ontario, agrees. For the most part, she says, “the claims that are made are enormously inflated.”


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
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.
Inside your body bacterial and other microbial cells live in close contact with your own cells, and in healthy conditions the thing that separates them from you is a layer of mucus. Between that layer of mucus and the inside of you is a layer of skin-like cells one-cell thick. One thing you have to understand about your gastrointestinal (GI) tract is that although it resides within you, it is really connected to the outside world, from your lips to your anus, and the things that protect you from the outside world are the mucus; the skin-like layer of cells with immune, nervous, and endocrine cells below it; and the beneficial microbes. At least 70 percent of your immune system is in your GI tract! This is why taking probiotics benefits the immune system greatly.
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.

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.
While taking a daily probiotic supplement may seem like an easy answer to cure common gut ailments, it’s always best to try for a food first approach, since you can get probiotics from the foods you eat. Probiotics can be found in foods such as yogurt, cheese, miso, sauerkraut, and kimchi. But, adding a supplement into the mix if you haven’t achieved the desired effect through diet alone can be effective.

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."


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.
Bottom line: Probiotics are a promising field of research and may one day be used to treat or help prevent many disorders. But there’s not enough solid evidence to recommend their widespread use. Vague claims that probiotics "support good digestive health" are meaningless. Larger, longer and better studies are needed to test specific strains for specific conditions and to determine the proper doses and regimens.
​​​​​​Lactobacilli dominate a healthy vaginal microbiota. Menstrual cycles, sexual activity, diet, certain medications, hygiene, and other factors can occasionally disrupt the vaginal microbiome. AZO Feminine Balance Daily Probiotic has been clinically demonstrated to contribute to the colonization of these important lactobacilli in the vagina.* The result: restoring the natural balance of good bacteria and yeast to maintain vaginal health.*
"The proprietary formula in this lotion supports a healthy microbiome of your skin promoting a more hydrated, stronger barrier function and protection from pathogens without harming the good stuff. Throw away your antibacterial soap and hand sanitizer and use this all over after your shower and after washing your hands," says Astarita, who is also a fan of the Nerium Prolistic Powder Pre & Probiotic Plus Vitamins ($45) and Be Well Probiotic Powder ($46) by Dr. Frank Lipman.
Yogurt: It can contain Streptococcus thermophilus, Lactobacillus bulgaricus, L. acidophilus, and Bifidobacterium bifidum. Research has shown links with yogurt to have positive effects on the gut microbiota and is associated with a reduced risk for gastrointestinal disease and improvement of lactose intolerance (especially among children), type 2 diabetes, cardiovascular disease, allergies and respiratory diseases, as well as improved dental and bone health.
Garden of Life RAW Probiotics are some of the most popular out there – and for good reason. Let’s start with the basics: You’ll get 85 billion CFUs and 31 to 33 probiotic strains out of your daily, whole-food, gluten-free, soy-free probiotic, which helps support the immune system, a healthy thyroid, nutrient absorption, digestive function, and a healthy microbial balance.
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