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.
Quick note about some formulations with multiple strains (including this one): Take a look at the label below and you’ll see that the supplement contains a mix of strains, but the label just says there is a total of 20 billion CFUs (how they measure the amount of bacteria). This does not tell us how much of each particular strain there is, and we want to know that there are at least 1 billion CFUs per strain to get a beneficial effect.
This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
As the best-selling author of Happy Gut and a medical doctor who specializes in gut health and once suffered from IBS (irritable bowel syndrome), I have experienced for myself, as well as see on a daily basis, how a disrupted gut flora opens the door for unfriendly microbes to step in and take over, creating all sorts of pandemonium that causes patients to gain weight, feel sick and tired, and become more disease-prone.
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.
Clinically shown to work in 7 days§, AZO Complete Feminine BalanceTM works differently because it contains the power of INTELLIFLORA,TM the only clinically proven blend with the 4 vaginal lactobacilli species most commonly found in healthy women.* Specially designed to restore the vagina’s microflora, it’s a safe and beneficial probiotic for women’s health—including pregnant women.*§ Add it to your daily regimen for help with protection and ongoing vaginal health support.*
Scientists are investigating probiotics, and their combined effects, by trying to classify the probiotic benefits of ingesting specific probiotic strains and understanding their role in the digestive tract. At present, the methodological and ethical limitations of human studies still make it difficult to fully understand the mechanisms of action of probiotics, but some explanations are available. Nevertheless, benefits linked to the consumption of probiotic strains have already been suggested (e.g. helping to support the immune system, help support digestive health), and others are still being investigated.
Here’s a startling fact: For every one human cell we have, there are ten bacteria cells in our body to match it. That means that the majority of DNA in our body isn’t even human; it’s from the 500 bacteria species that call us home.1 Thinking about that much bacteria might have your skin crawling, but the relationship between human and bacteria is really a perfect synergy: we give bacteria room and board, and in return, they work hard to protect our intestinal health, which ultimately protects the health of our immune system and overall well-being. But if we have that much bacteria already living in our gut, you might be thinking to yourself, what are probiotics’ benefits?
Probiotics are a big and rapidly growing business and are now among the most popular dietary supplements. The term probiotic refers to dietary supplements (tablets, capsules, powders, lozenges and gums) and foods (such as yogurt and other fermented products) that contain “beneficial” or “friendly” bacteria. The organisms themselves are also called probiotics.
Probiotics stick around for a while, though for how long isn’t precisely clear. You have to keep taking them to continue to reap the benefits. Further, getting a wide variety of strains into your system is beneficial. “Periodically mixing up your probiotic supplement is also a good way to ensure that you get different health-building strains in your health regime,” says Dr. Cook.

By eating probiotic-rich foods and maintaining good intestinal flora, a person can also help to maintain a healthy immune system. And that has real world effects: for example, in one small study of students, those who were given a fermented dairy drink (instead of milk) displayed increased production from lymphocytes -- a marker of immune response.
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.

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.


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.
If you’ve ever experienced the crippling pain of a urinary tract infection, you’ve probably encountered an article or two about the benefits of cranberries for warding off bacteria in the urinary tract. While it may seem like an old wives tale, cranberries contain D-Mannose that is naturally acidic. This compound has been said to prevent unwanted bacteria build-up, and some claim it can even stop a urinary tract infection dead in its tracks!
There are four significant takeaways from this study: (1) murine gut mucosal probiotic colonization is only mildly enhanced by antibiotics, (2) Human gut mucosal probiotic colonization is significantly enhanced by antibiotics, (3) After taking antibiotics, probiotics delay gut microbiome and transcriptome reconstitution in mice and humans, (4) Autologous fecal microbiome transplant (aFMT) restores mucosal microbiome and gut transcriptome reconstitution. 
In these cases, IBS is essentially just TMI. “For the colon to be functioning properly, it needs to be contracting and relaxing in a way that is conducive to regular bowel movements that occur at predictable times and don’t occur too frequently or too rarely," Lebwohl says. "And the bowel needs to be giving infrequent feedback to the brain. People should not be getting updates from their bowel in terms of cramps or the feeling of having to have a bowel movement too often. Yet, people with IBS get very frequent unsolicited ‘progress reports’ from the bowel.”
Best Probiotic says that Suprema Dophilus, manufactured and distributed by Vitabase, enjoys the highest customer rating in the market. Specially coated to help the bacteria spread through your entire digestive tract, its website claims over four billion viable cells per capsule, including five lactobacillus strains and three bifidobacteria cultures. Best Probiotic says that Suprema Dophilus also contains fructo-oligosaccarides to increase the life span of the bacteria.
There is one Voluntary Certification Program by which a supplement manufacturer can choose to be evaluated. ConsumerLab.com (CL) is the leading provider of independent test results and information to help consumers and health-care professionals identify the best quality health and nutrition products. Products that have passed their testing for identity, strength, purity, and disintegration can print the CL Seal of Approval on their product. This is one step toward being confident that one is getting the amount and type of probiotic promised by the manufacturer.
Unlike many of the probiotics on the market today for women, Vitamin Bounty’s formula is fermented naturally and encased in a delayed-release capsule for more efficient digestion. Specifically, this capsule helps to protect the micro-organism strains from stomach acid, which can dissolve them before your gut has a chance to absorb all of their healthy goodness. With this Women’s Pro-Daily Probiotic design, you can expect more cultures and, as a result, fewer stomach upsets and feminine health problems!

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."
Jotham Suez, Niv Zmora, Gili Zilberman-Schapira, Uria Mor, Mally Dori-Bachash, Stavros Bashiardes, Maya Zur, Dana Regev-Lehavi, Rotem Ben-Zeev Brik, Sara Federici, Max Horn, Yotam Cohen, Andreas E. Moor, David Zeevi, Tal Korem, Eran Kotler, Alon Harmelin, Shalev Itzkovitz, Nitsan Maharshak, Oren Shibolet, Meirav Pevsner-Fischer, Hagit Shapiro, Itai Sharon, Zamir Halpern, Eran Segal, Eran Elinav. Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT. Cell, 2018; 174 (6): 1406 DOI: 10.1016/j.cell.2018.08.047
"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.
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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.
The concept of probiotics is credited to Élie Metchnikoff, a Russian scientist born in the mid-1800s, whose work provided profound insights into immunology and microbes. He developed a theory about aging that over the years had been forgotten in mainstream medicine but is now embraced by many scientists: namely, that health is influenced by toxic bacteria in the gastrointestinal (GI) tract. He is said to have noticed that people who lived to be over 100 years old in the Balkan States and Russia drank sour milk, which we now call yogurt or kefir, every day. In fact, Bulgarian yogurt cultures even today are regarded as highly therapeutic.
You may have heard that taking vitamin C or zinc is helpful, preventively or during sickness. This is because vitamin C and zinc improve the functioning of cells of your innate immunity, your first line of defense against pathogens like the flu. They also are involved in the generation of and protection against the inflammatory response caused by the battle with the flu.
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.
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.
You experience that afternoon slump and reach for a candy bar or a sugar-laden coffee. Or maybe you go through your day, starting with a breakfast of doughnuts or sugary cereal, and then proceed to sodas for drinks, cookies to snack on, dessert after dinner, and finally to a nighttime snack of ice cream. You know that feeling; it’s that I-have-to-have-something-sweet-and- I-have-to-have-it-NOW feeling. 

CFU: This is the number of "colony forming units" present in each dose, which are measured in the billions. And while more isn't always better, "you want at least 20 to 50 billion CFU," says Dr. Nazareth. Just for reference, a very high dose is 400 CFU, which most experts agree is not necessary unless your health care practitioner specifically recommends this for you. It's also important to check for the guaranteed CFU upon expiration, which should be listed clearly. "Some products only guarantee the CFU number at the time of manufacturing, therefore will be less potent by the time the product reaches your home," she says.
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.
Popular probiotic foods include yogurt, kimchi, sauerkraut, and kombucha. While delicious, these foods don’t claim specific amounts of whatever microorganisms they may contain. By contrast, Probiotic All-Flora is optimally formulated with the right amounts of the right strains to deliver researched benefits. The label lists out the DNA-tested flora that make up that ideal 10 billion CFU in just one capsule daily. So probiotic supplements actually have more reliable strain benefits than probiotic foods.
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.
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.
Once GI experts realized there is more to the lower gut than first assumed, the push to understand the diverse roles these bacteria play became urgent. Many mysteries still need solving, but clinical evidence increasingly indicates that people in good health should optimize lower gut bacteria. You can accomplish this by eating prebiotics to encourage the growth of your existing gut microbes, and probiotics to add to the ones that are already there.
Quick note about some formulations with multiple strains (including this one): Take a look at the label below and you’ll see that the supplement contains a mix of strains, but the label just says there is a total of 20 billion CFUs (how they measure the amount of bacteria). This does not tell us how much of each particular strain there is, and we want to know that there are at least 1 billion CFUs per strain to get a beneficial effect. 

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.

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.
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.

In the past five years, for example, several combined analyses of dozens of studies have concluded that probiotics may help prevent some common side effects of treatment with antibiotics. Whenever physicians prescribe these medications, they know they stand a good chance of annihilating entire communities of beneficial bacteria in the intestine, along with whatever problem-causing microbes they are trying to dispel. Normally the body just needs to grab a few bacteria from the environment to reestablish a healthy microbiome. But sometimes the emptied niches get filled up with harmful bacteria that secrete toxins, causing inflammation in the intestine and triggering diarrhea. Adding yogurt or other probiotics—especially the kinds that contain Lactobacillus—during and after a course of antibiotics seems to decrease the chances of subsequently developing these opportunistic infections.

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.”


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.
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