Perturbation of bacterial microflora of the gastrointestinal (GI) tract may play an important role in the pathophysiology of some GI disorders. Probiotics have been used as a treatment modality for over a century. They may restore normal bacterial microflora and effect the functioning of the GI tract by a variety of mechanisms. Probiotics are not currently regulated and only few randomized controlled trials exist investigating their efficacy in different GI disorders. They are available in a variety of formulations and delivery systems making interpretation and comparison of studies even more difficult. The efficacy of probiotics, either as a single strain or a combination of probiotics, has been tested in antibiotic-associated diarrhea, Clostridium difficile colitis, infectious diarrhea, ulcerative colitis, Crohn’s disease, pouchitis, and irritable bowel syndrome, among other disorders. Results of the studies are reviewed in this article and recommendations for probiotic use in these disorders are made. Although probiotics appear to be generally safe in an outpatient setting, the situation may be different in immunocompromised, hospitalized patients who may be at a greater risk of developing probiotic sepsis. No studies exist addressing the issue of safety specifically. Many questions regarding use of probiotics in GI disorders remain to be answered in future studies, such as most optimal doses, duration of treatment, physiological and immunological effects, efficacy of specific probiotics in specific disease states, and safety in debilitated patients.

Adding probiotics to your diet can be overwhelming. Besides picking a brand, you'll also have to consider what type of formula you prefer. Probiotics can also be packed into powder, such as this one from Garden of Life. You mix one scoop (one-third teaspoon) of it with water or juice to make one serving. Three servings a day are recommended, though the manufacturer suggests starting with one and gradually increasing the amount.


Rachel Allen is a writer at Hyperbiotics who's absolutely obsessed with learning about how our bodies work. She's fascinated by the latest research on bacteria and the role they play in health, and loves to help others learn about how probiotics can help the body get back in balance. For more ideas on how you can benefit from the power of probiotics and live healthier days, be sure to subscribe to our newsletter. To learn more about how a healthy microbiome can enrich your life, subscribe to our newsletter.
Probiotics, like all strategies for helping promote your health, might not work for everyone. People have different diets, the microbes colonizing their gut are specific to each of us and everyone’s physiology is unique. Research often shows that some people respond to a specific probiotic strain and others do not. So if you feel a probiotic is something you’d like to use, one strategy is to try a product for about a month. If you don’t see a benefit, then perhaps it’s not the right one for you.
However, it’s not just digestive woes that probiotics can help address. A clinical case series followed 300 patients who took a probiotic mixture of L. acidophilus and L. bulgaricus. They documented that 80% of acne patients had some degree of clinical improvement, particularly effective in inflammatory acne. Later, an Italian study involving 40 patients found L. acidophilus and B. bifidum supplementation produced better clinical outcomes in acne as well as better tolerance and compliance with antibiotics [2].

Clinical Guide to Probiotic Products Available in the United States and Clinical Guide to Probiotic Products Available in Canada. 2017 Editions. An independent tool for healthcare professionals, developed by the Alliance for Education on Probiotics (AEP) and made possible through an unrestricted education grant by Danone, Ferring Pharmaceuticals, Metagenics, P&G and Seroyal. For an interactive version, free mobile download: USA version:  Google Play and the App Store; Canada version: App Store and Google Play.


The trillions of bacteria in your gut play many roles including encouraging proper intestinal permeability (keeping things within your gut that shouldn’t slip out) and keeping out unfavorable bacteria, yeast, and parasites. You’ll always have some bad guys, but you want to keep your gut predominantly filled with good bacteria. To do that, eat plenty of fermented food like unpasteurized sauerkraut, kimchi, and no-sugar-added coconut yogurt. You might also want to supplement with a professional-quality probiotic. Look for dairy-free probiotics that contain at least 15 billion CFUs each of Lactobacillus and Bifidobacterium (a total of 30 billion CFUs) guaranteed by the manufacturer through the expiration date. Take on an empty stomach once or twice a day for at least three months, and keep probiotics refrigerated after opening to maintain their freshness and potency. If you have a leaky gut or inflammatory bowel disease (such as Crohn’s or ulcerative colitis), you may need to take up to a total of 200 billion CFUs daily. For those and other conditions that require very high-dose probiotics, I recommend working with a gut-health specialist.
Further, there’s still a lot we don’t know. A recent study published in Cell compared how the microbiome of the gut reconstituted itself after antibiotic treatment with and without probiotic administration. The researchers found that probiotics (which might have improved diarrhea symptoms) led to a significant delay in microbiome reconstitution, if it occurred at all. And — again — this study was with purified strains of bacteria, which is not what you’re getting in probiotic-containing food.
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.

Unfortunately, many commercial brands don’t measure up. They are unstable in stomach acid. Quality control measures aren’t intact, including ensuring supplements have been handled correctly and maintain their freshness. Moisture slipping into probiotic supplements can reduce their efficacy. Companies that use bioshield capsules produce higher quality probiotic supplements that are able to endure the stomach acid, releasing their contents within the small intestine, where a more alkaline environment ensures the survival of the bacteria.


Even for healthy people, there are uncertainties about the safety of probiotics. Because many research studies on probiotics haven’t looked closely at safety, there isn’t enough information right now to answer some safety questions. Most of our knowledge about safety comes from studies of Lactobacillus and Bifidobacterium; less is known about other probiotics. Information on the long-term safety of probiotics is limited, and safety may differ from one type of probiotic to another. For example, even though a National Center for Complementary and Integrative Health (NCCIH)-funded study showed that a particular kind of Lactobacillus appears safe in healthy adults age 65 and older, this does not mean that all probiotics would necessarily be safe for people in this age group.
The newest trend in probiotics is customized formulations that are said to be based on your unique microbiome needs. Companies develop them after testing your stool sample for different microbes, and then selecting probiotics they say you lack in your gut. “While it may be a step in the right direction, the science and technology have a long way to go before this is a viable option,” says Dr. Rawls. 

In the new study, the researchers analyzed information from 15 healthy volunteers who took either a probiotic product containing 11 strains of bacteria, or a placebo, for four weeks. The participants also underwent colonoscopies and upper endoscopies before they took the probiotics or the placebo, and again after the four-week treatment period. (An upper endoscopy looks at the upper part of the digestive tract.) During these procedures, the researchers took samples from inside participants' guts.
Though capsules are ideal for quick, convenient consumption, powdered products are a great choice for anyone who wants to mix their probiotics with shakes or smoothies. The Hyperbiotics Organic Prebiotic Powder is a totally taste-free prebiotic powder that has inulin, FOS, resistant starch, and dietary fiber to help keep your gut health in line. Unlike probiotics, prebiotics works to nourish and grow the bacteria that is already in your body. This supplement also has acacia fiber, which is said to help suppress appetite and reduce gas and bloating. You can take between one and three scoops of powder a day, depending on how much microbial support you’re looking for. Each container comes with 375 grams or roughly 54 servings, and it doesn’t need to be refrigerated. 

Kerry Torrens is a qualified Nutritionist (MBANT) with a post graduate diploma in Personalised Nutrition & Nutritional Therapy. She is a member of the British Association for Nutrition and Lifestyle Medicine (BANT) and a member of the Guild of Food Writers. Over the last 15 years she has been a contributing author to a number of nutritional and cookery publications including BBC Good Food.
Probiotics are generally considered safe8 for most healthy people, but may cause gastrointestinal discomfort (abdominal tenderness, pain, gas, and/or diarrhea) if intake exceeds individual needs. People with certain health conditions like suppressed immunity or sensitivity to probiotics may experience more severe side effects9. Probiotics can also interact with some medications. Please consult your doctor before starting any new supplement.
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
Bad sleep creates a vicious cycle that damages your gut. Insufficient or poor-quality sleep also makes you crave something sweet or starchy because your body is tired and demands quick energy to keep it going. By the next morning, your digestive system is out of sync, and eating can actually make you feel sick to your stomach. With a few exceptions like shift workers and new moms, the choice to have regular sleep times is yours. Regular sleep patterns and at least seven hours of uninterrupted nightly sleep are crucial for gut and overall health.
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.
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