Probiotics are live microorganisms that are thought to have health benefits, as the National Institutes of Health (NIH) reports. These bacteria and yeast are believed to help populate our guts with beneficial microbes, according to Mayo Clinic, and can be found in fermented or unpasteurized foods including yogurt, kefir, sauerkraut, and kimchi, as well as, yes, supplements.
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:
Yet that’s how probiotics are often offered. They can be distributed in the United States as food, supplements or drugs. The regulations for each are very different. Most people looking for probiotics don’t see the distinctions. Ideally, the ways in which we use and consume probiotics would conform to the data and evidence that back them up. That rarely happens.
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.
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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)
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.”
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.
The Golive Berry Probiotic and Prebiotic Supplement Blend is perfect for tossing in your bag or keeping in your desk. Each packet includes 15 billion CFUs and 15 different probiotic strains. It also has a soluble fiber prebiotic to promote the growth of good bacteria in your body. Each packet contains 30 calories and comes in five flavors including pomegranate, melon cucumber, citrus blueberry, and a flavorless option. It can be mixed in any hot or cold drink, but we recommend tossing the flavored packet into a bottle of water. You’ll get 10 packets in each order.
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.
The best case for probiotic therapy has been in the treatment of diarrhea. Controlled trials have shown that Lactobacillus GG can shorten the course of infectious diarrhea in infants and children (but not adults). Although studies are limited and data are inconsistent, two large reviews, taken together, suggest that probiotics reduce antibiotic-associated diarrhea by 60%, when compared with a placebo.
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.
They probably are. Lebwohl says probiotics may decrease the risk of getting diarrhea during the course of taking antibiotics, and may also play a role in specifically preventing the development of the dreaded antibiotic-related super diarrhea called C. difficile or C. diff. Antibiotics can wipe out the good bacteria that keep you from getting sick if you’re exposed to C. diff, or if you already have it in your system. C. diff symptoms can range from a moderate watery diarrhea several times a day to severe infections, which can be accompanied by fever, bloody stools, rapid heart rate, and can even lead to kidney failure. 500,000 Americans were infected with C. diff in 2015 and 15,000 died from it.
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.
For women searching for a double-duty probiotic that can ease digestive symptoms while warding off urinary tract infections, look no further than the HyperBiotics PRO-Women Probiotics with Cranberry Extract and D-Mannose. Specifically designed to combat urinary symptoms while maintaining healthy gut bacteria, this formula is ideal for women of all ages that want to improve their urinary health.
The prebiotic comes before and helps the probiotic, and then the two can combine to have a synergistic effect, known as synbiotics. A prebiotic is actually a nondigestible carbohydrate that acts as food for the probiotics and bacteria in your gut. The definition of the effect of prebiotics is the selective stimulation of growth and/or activity(ies) of one or a limited number of microbial genus(era)/species in the gut microbiota that confer(s) health benefits to the host. The health benefits have been suggested to include acting as a remedy for gastrointestinal (GI) complications such as enteritis, constipation, and irritable bowel disease; prevention and treatment of various cancers; decreasing allergic inflammation; treatment of nonalcoholic fatty liver disease (NAFLD), and fighting immune deficiency diseases. There has also been research showing that the dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase calcium absorption as well as bone calcium accretion and bone mineral density. The benefits for obesity and type 2 diabetes are growing as recent data, both from experimental models and from human studies, have shown particular food products with prebiotics have influences on energy homeostasis, satiety regulation, and body weight gain.
"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.
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.
The probiotic industry is booming, but the benefits of probiotic products and the quantity of viable bacteria they contain can vary. So, instead of adding bacteria from an outside source, you might be better off consuming prebiotics, like fermentable fiber, which support your own beneficial bacteria, Dr. Cresci says. Good dietary sources of prebiotics include dried beans and other legumes, garlic, asparagus, onions, leeks, certain artichokes, green bananas and wheat. Prebiotic supplements are available, as well.
Several large-scale studies and two meta-analyses have confirmed that probiotics should be a major consideration in determining natural remedies for diabetes. In a massive study involving almost 200,000 subjects and a total of 15,156 cases of type 2 diabetes, researchers confirmed that a higher intake of probiotic-rich yogurt reduced the risk of developing diabetes.
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.
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.
"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."
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.
If you’re looking for a great probiotic you can take every day to target everything from gut to skin health, the Culturelle Daily Probiotic is our top choice. Each capsule has 10 billion active cultures of 100 percent Lactobacillus GG, a probiotic that helps curb gas, bloating, and upset stomach, and works to boost your immune system. Each capsule has the probiotic equivalent of 10 cups of yogurt and is dairy-free, sugar-free, and gluten-free. This container comes with 30 pills to be taken just once a day (most recommend taking it at night, especially when you’re just starting on probiotics).
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
These statistics are staggering, yet poor gut health actually affects much greater numbers than these statistics illustrate because your digestive health affects every physiological system in your body. How is this such a complex system? Well, for one, the human microbiome contains 360 times more protein-coding genes than human genes themselves contain.
"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," says Segal. "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."
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.
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