Probiotics are found in everything from chocolate and pickles to hand lotion and baby formula, and millions of people buy probiotic supplements to boost digestive health. But new research suggests they might not be as effective as we think. Through a series of experiments looking inside the human gut, researchers show that many people's digestive tracts prevent standard probiotics from successfully colonizing them. Furthermore, taking probiotics to counterbalance antibiotics could delay the return of normal gut bacteria and gut gene expression to their naïve state. The research publishes as two back-to-back papers on September 6 in the journal Cell.
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.
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.
Suez and colleagues investigated the recovery of the gut microbiota after antibiotic treatment and found that probiotics might perturb rather than aid this process. The probiotics rapidly colonised the gut but prevented the normal microbiota from repopulating for up to 5 months. While likely to be considerably less appealing, the group who received autologous faecal microbiota transplantation recovered their microbiota the quickest, with the composition of the microbiota returning to normal within days. Furthermore, Zmora and colleagues showed that colonisation occurred in highly individualised patterns, with some people's gastrointestinal tracts rejecting probiotics and others allowing colonisation by the probiotic strain, meaning that many individuals taking probiotic supplements are simply wasting their money.

The root of the word probiotic comes from the Greek word pro, meaning "promoting," and biotic, meaning "life." The discovery of probiotics came about in the early 20th century, when Elie Metchnikoff, known as the "father of probiotics," had observed that rural dwellers in Bulgaria lived to very old ages despite extreme poverty and harsh climate. He theorized that health could be enhanced and senility delayed by manipulating the intestinal microbiome with host-friendly bacteria found in sour milk. Since then, research has continued to support his findings along with suggesting even more benefits.
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.
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.
The above line of probiotics is also a favorite of Engelman. "I like Nerium International's new Prolistic Pre & Probiotic Plus Vitamins ($45) because it combines prebiotics, probiotics, and vitamins," Engelman explains. "It supports overall health while targeting digestive function. It contains two types of prebiotics and two strains of probiotics to help enhance levels of beneficial microflora and balance levels of healthy bacteria in the digestive system. Additionally, it contains B vitamins, vitamin C, and vitamin D, which work to enhance the body's immune system and support natural energy production."
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
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.
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.
This mildly sour, chewy bread is made with a lactic acid starter that contains strains of lactobacillus, a friendly type of bacteria that adds good microbes into the bakery staple. Sourdough may be the healthiest bread choice if diabetes is a concern for you: one 2008 study found that people with pre-diabetes who ate sourdough bread had less of a blood sugar spike compared to when they ate bread made with baker's yeast. (Experts also say fiber-rich whole grain bread can also reduce a post-meal blood sugar spike.) The researchers credit the lactic acid for the favorable effect.
Caution needs to be taken by everyone who chooses to take these supplements, but this is especially true for children, pregnant women, elderly people, and people with compromised immune systems. For people with compromised immune systems due to disease or treatment for a disease (such as cancer chemotherapy), taking probiotics may actually increase one's chances of getting sick. It has been shown that the use of various probiotics for immunocompromised patients or patients with a leaky gut has resulted in infections and sepsis (infection of the bloodstream). One case of bacteremia (bacteria in the bloodstream) was recently found when someone with active severe inflammatory bowel diseases with mucosal disruption was given Lactobacillus GG. Always speak with a doctor before taking any supplement under these circumstances.
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. 

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.
Made from fermented cabbage and other vegetables, sauerkraut is not diverse in probiotics but is high in organic acids (what gives food its sour taste) that support the growth of good bacteria. Sauerkraut is extremely popular in Germany today. It is high in vitamin C and digestive enzymes. It’s also a good source of natural lactic acid bacteria, such as lactobacillus.
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.∗

Consuming probiotics regularly will reduce the risk of this. "The concept is that if we have an unhealthy, unbalanced gut environment, toxins can be released into the bloodstream and cause inflammation throughout the body," Engelman adds. "This shift in gut flora and the subsequent inflammation can cause a flare-up in the skin of those who are predisposed to acne, eczema, or rosacea."
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.”
Candida yeast species, on the other hand, can cause numerous infections in and on you. Although they are usually present in controlled amounts, Candida overcomes your usual defenses and establishes itself when conditions are favorable, such as when you take antibiotics and many beneficial bacteria, which normally would control Candida, are killed. Unlike the Saccharomyces yeasts, which are not invasive, Candida species form hyphae, finger-like projections that penetrate tissues, causing deep infections that are difficult to eliminate. Candida is also able to weaken your immune defenses.
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].
Some studies suggest that certain probiotic strains may also help in mild to moderate ulcerative colitis and possibly for bloating and gas in irritable bowel syndrome (IBS). Probiotic supplements, on the whole, “improve global symptoms, bloating, and flatulence in IBS,” by modifying the gut microbiome, according to a 2014 monograph from the American College of Gastroenterology. As IBS researchers said in a paper in Gastroenterology & Hepatology in 2015, “The concept of manipulating the microbiome is one of the most promising new ways in which to treat patients with IBS, but there is still much to learn.”
Probiotic supplements are not drugs (in the United States), although super potent forms may be obtained through prescription. As such, they are not intended to treat or cure any diseases, mental or physical. Probiotics benefit and complement a healthy way of life filled with nutritious food, adequate exercise, restorative sleep, beneficial social engagements, reduced exposure to toxins, and hydration with clean water.
Probiotic therapy may also help people with Crohn's disease and irritable bowel syndrome. Clinical trial results are mixed, but several small studies suggest that certain probiotics may help maintain remission of ulcerative colitis and prevent relapse of Crohn's disease and the recurrence of pouchitis (a complication of surgery to treat ulcerative colitis). Because these disorders are so frustrating to treat, many people are giving probiotics a try before all the evidence is in for the particular strains they're using. More research is needed to find out which strains work best for what conditions.

Vitamin Bounty’s probiotic contains a variety of well-studied strains and a competitive 25 Billion CFU. It also contains a natural prebiotic resistant starch, rice flour, to fuel the strains this probiotic supplies. Over 95% of Pro 25’s strains were still active and viable, the second highest observed strain viability out of all probiotics reviewed-to-date!


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.
The bad news about constipation is that there can be many causes, from simple causes like dehydration and lack of fiber to complicated structural causes or disease. While constipation may seem to be only a nuisance that causes uncomfortable symptoms such as abdominal bloating or pain, the truth is that constipation increases the risks of several diseases.
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].
We also found strains linked to five other health benefits like weight loss and lowering cholesterol. We feature options for those cases below, but they aren’t top picks because those use cases aren’t as heavily researched as immune health or IBS relief. Still, chances are any probiotic supplement is going to make some improvement to your digestive health, so don’t be afraid to experiment.
This mildly sour, chewy bread is made with a lactic acid starter that contains strains of lactobacillus, a friendly type of bacteria that adds good microbes into the bakery staple. Sourdough may be the healthiest bread choice if diabetes is a concern for you: one 2008 study found that people with pre-diabetes who ate sourdough bread had less of a blood sugar spike compared to when they ate bread made with baker's yeast. (Experts also say fiber-rich whole grain bread can also reduce a post-meal blood sugar spike.) The researchers credit the lactic acid for the favorable effect.
Although some probiotics have shown promise in research studies, strong scientific evidence to support specific uses of probiotics for most health conditions is lacking. The U.S. Food and Drug Administration (FDA) has not approved any probiotics for preventing or treating any health problem. Some experts have cautioned that the rapid growth in marketing and use of probiotics may have outpaced scientific research for many of their proposed uses and benefits.
I currently have stage 1 breast cancer; history of pseudo inflammatory eye tumor, stroke, digestion issues, constipation, candida and toenail fungus. No one can tell me cause of inflammation throughout my body. Would BlueBiotics be my best choice? Does it have lactose? Tried about everything on market but need something that targets the above. Thank you.
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But sometimes you need a little help from outside sources in order to secure those benefits, which is why a lot of experts recommend getting an extra hit of probiotics through food. Fermented options — think keffir, sauerkraut, and kimchi — are a great place to start, says the International Scientific Association of Probiotics and Prebiotics, as are these other surprising foods with probiotics.
Probiotics have also been researched for how they support the immune system. Studies suggest that probiotics can improve how the immune system functions such as by decreasing upper respiratory tract infections in adults and reducing the need for antibiotics. Studies in children show that a regular diet including probiotics reduces colds and flu-like symptoms and improves attendance in preschool and day care settings.
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.
The bottom line: Stick to trusted whole food sources of probiotics if you don’t know a probiotic supplement brand you trust. “Kimchi, pickled beets, Greek yogurt and sauerkraut are great sources of probiotics. If you don’t like them, throw them into a food you do like, like a smoothie, and add your favorite fruit to help mask the flavor,” Taub-Dix says.
Prebiotics and supplementary ingredients — For probiotic bacteria to grow, they also need prebiotics. High-quality probiotic supplements have both prebiotics and other ingredients designed to support digestion and immunity. Examples of these ingredients are (preferably fermented) flaxseed, chia seed, cañihua seed, astragalus, ashwagandha, hemp seed, pumpkin seed, milk thistle, peas, ginger, mung bean and turmeric.
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