Eating foods rich in good bacteria and using probiotic supplements may help provide protection from inflammatory bowel diseases, including ulcerative colitis and Crohn’s disease. The evidence is stronger, however, for an improvement in ulcerative colitis, while Crohn’s disease may not benefit as greatly. In addition, there is ongoing research studying the role of probiotics in gluten issues, including celiac disease.
In the United States, most probiotics are sold as dietary supplements, which do not undergo the testing and approval process that drugs do. Manufacturers are responsible for making sure they're safe before they're marketed and that any claims made on the label are true. But there's no guarantee that the types of bacteria listed on a label are effective for the condition you're taking them for. Health benefits are strain-specific, and not all strains are necessarily useful, so you may want to consult a practitioner familiar with probiotics to discuss your options. As always, let your primary care provider know what you're doing.
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.
The best probiotic manufacturers will list their potency (in CFUs) at the time of expiration, ensuring you get the dosage you’re paying for. Dr. David Perlmutter, board-certified neurologist, American College of Nutrition Fellow, and author of The New York Times bestsellers "Brain Maker" and "Grain Brain" puts it this way: “Avoid products that indicate a specific number of bacteria ‘at the time of manufacture,’ and instead look for products that, like other supplements, have a shelf life.” Each of our top picks clearly shows a specific “best by” or “expires on” date on its bottle.

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.
The idea that consuming probiotics can boost the ability of already well-functioning native bacteria to promote general health is dubious for a couple of reasons. Manufacturers of probiotics often select specific bacterial strains for their products because they know how to grow them in large numbers, not because they are adapted to the human gut or known to improve health. The particular strains of Bifidobacterium or Lactobacillus that are typically found in many yogurts and pills may not be the same kind that can survive the highly acidic environment of the human stomach and from there colonize the gut.
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.
"I usually recommend Garden of Life, BioK or Megafoods brand," says Shapiro. "I also recommend starting with about 30 billion CFU and making sure your supplement has at least 12 different strains. And if you don't eat a diet high in fruits, vegetables, nuts, seeds, and whole grains that provide fiber for the probiotics to live off of, make sure you're the one you are taking contains prebiotics as well.
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."

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.
Fermenting a cucumber into a pickle amps up a cuke's powers, infusing the crunchy veggie with probiotics. Like sauerkraut, not all pickles offer the good bacteria, though. Look for those made with brine (salt and water) rather than vinegar. These brands will list "live cultures" on the label (like Bubbies). You can also use water, salt, and spices to naturally culture pickles and other veggies—like beets, green beans, and carrots—at home with delicious results. One warning: remember that pickles are salty—one dill can easily offer up more than 10% of your sodium needs in a day.
Make sure dosages are listed in CFU, colony forming units. (Most brands list CFU in billions now: so 30 billion CFU, 100 billion CFU, and so on.) For one, this means that the bacteria strains are living, which is essential. When you’re looking at the cost of products, be sure to look at the cost per unit. I spoke to a woman the other day who had bought probiotics that had 2 billion CFU per capsule. In comparison, to get the 30 billion CFU I recommend, she’d have to take essentially half of her bottle to get the same dosage as one of our capsules.
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.
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.
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.
"I usually recommend Garden of Life, BioK or Megafoods brand," says Shapiro. "I also recommend starting with about 30 billion CFU and making sure your supplement has at least 12 different strains. And if you don't eat a diet high in fruits, vegetables, nuts, seeds, and whole grains that provide fiber for the probiotics to live off of, make sure you're the one you are taking contains prebiotics as well.
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].
Afif Ghannoum said the key insight, one that he called groundbreaking, is that his father’s team found that fungi and microbes were cooperating in the construction of the plaques.  He said election microscope images show the filaments of the fungi being incorporated into the carbohydrate ‘armor’ that the bacteria start to secrete once enough individual cells have gathered at a certain location. Without the addition of the digestive enzyme to their product, he said that the plaques, once adhered to the intestinal wall, would be difficult to attack.
Sugar is so easily accessible in Westernized cultures that it is easy to overindulge in it. But why do you crave it? There are several reasons. One, sugar usually means sucrose, which is composed of glucose and fructose. Glucose is the sugar in your blood, so consumption of sugar results in a temporary boost of energy. However, that blood-sugar spike causes insulin to be released to usher the sugar into cells for energy or fat storage, and shortly afterward your blood sugar drops. So then you feel a slump and reach for something to bring your blood sugar back up: more sugar.
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.
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.”
Microbes are tiny organisms (bacteria, viruses, parasites, or fungi) -- so tiny that millions can fit into the eye of a needle -- that are so powerful that an imbalance in the body is related to numerous diseases. These microorganisms can be found in almost every part of the human body, living on the skin, in the nose, and in the gut. There are trillions of these microorganisms in our bodies. They outnumber human cells by 10 to one, but due to their small size, they only make up 1%-3% of a body's total mass.
I did the “milk test” on these New Rythm probiotics, along with Culturelle I had purchased in 2 different states (TX & MA, as I was traveling); my mother’s CVS brand acidophilus; and one “control” cup with milk only (so, 5 cups total in my experiment). The New Rythm became a solid yogurt consistency, while the other 4 remained liquids. I did the experiment twice, just to be sure of the results. I could not believe it!!! New Rhythm is my brand, hands down!!! I also would like to mention that my product usually arrives the day after it ships. So it will take a few days to ship when I select standard shipping, which is to be expected, but it doesn’t stay in transit long which is ideal for preserving the living cultures.
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.
Probiotics help tip the balance back in favor of the good bacteria. In doing so, they may provide some relief if you have irritable bowel syndrome (IBS), ulcerative colitis, acute infectious diarrhea, and diarrhea associated with antibiotic use or Clostridium difficile (C.diff) infection. They also can boost your immunity, fight inflammation and potentially have beneficial effects on cholesterol.

If these issues and many others are connected to gut health, then what elements are essential for digestive health? Consider this: According to the National Institute of Diabetes and Digestive and Kidney Diseases, upward of 60 million to 70 million Americans are affected by digestive diseases. In addition, digestive disease and disorders cost the United States over $100 billion per year.

There have been multiple additional studies which link stress to changes in gut bacteria, so there does appear to be some sort of link. But Lebwohl says it’s not enough to recommend widespread use in clinical practice. He referred to these as “hypothesis-generating studies,” which should lead to concrete clinical trials in which the probiotics are tested against a placebo. “These are important studies,” he says. “But it’s premature to call them practice-changing studies.”
To boost the immune system, B. Lactis is a promising choice. One study had participants taking either a probiotic or a placebo for 6 weeks. At the end of the period, researchers measured antibody levels and found greater increases in antibodies of the B. Lactis group than in placebo participants, concluding that this probiotic may help improve immune function [1]. In addition, a 2009 study found that supplementation of the strain B. Lactis DN-173 led to self-reported improvements in digestive comfort [2].
Two dangerous diseases in newborns, necrotizing enterocolitis (NEC) and neonatal sepsis, may meet their match with well-designed probiotic supplements. Both of these conditions are common in premature babies and are most dangerous in low birth weight and very low birth weight infants. Research has confirmed that when a pregnant mother takes high-quality probiotics during pregnancy, her baby is significantly less likely to develop either NEC or sepsis, particularly when the baby is breastfed after birth (and mom is still taking the supplements) and/or when probiotics are added to formula. A probiotic supplement with multiple strains seems to be the most effective in these cases.
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Previous studies have been contradictory, with some yielding more positive results about the benefits of probiotics, but most of them looked at probiotics in stool samples, not directly in the gut itself. In the new research, the scientists used more invasive methods to take samples of gut bacteria directly from different areas of the digestive system.


While Lebwohl isn't comfortable endorsing a specific brand publicly, he did say "a widely used brand in which the compound is bifidobacteria or lactobaccilus seems like a reasonable way to go in a patient who is eager to give this a try, but would be best done under the supervision of a healthcare professional.” He does advise looking for a supplement with between 1 billion and 10 billion colony-forming units, or CFUs.
BlueBiotics is a good product to start with and then evaluate from there. The cold is actually good for probiotics as freezing them extends the life of the cultures. Companies who freeze dry their probiotics (which if I’m not mistaken, each of these companies do), but having them shipped in very high temperatures can and does kill probiotic microorganisms so it’s definitely a concern. Ideally, it’s better to stock up during the winter so that you don’t have your product stuck in the back of a hot truck before it gets to you.
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.”
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.
Until recently, testing of probiotics by ConsumerLab.com found that some products had far lower amounts of live organisms than claimed on the labels. But in 2018, it found that 17 out of 18 products tested contained the amounts listed; none exceeded limits for heavy metal contaminants. In contrast, in 2016, a study in Pediatric Research found that only one out of 16 Bifidobacterium longum supplements tested contained the species named on the label.
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, 2018; 174 (6): 1388 DOI: 10.1016/j.cell.2018.08.041
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