Does your gut need a reset?

Yes, I'm Ready

Do you want to start feeling better?

Yes, Where Do I Start?

Do you want to start feeling better?

Yes, Where Do I Start?

Digestive Enzymes vs. Probiotics: Which Supplement Is Best?

Two Great Options for Better Digestive Health

Probiotics and digestive enzymes are two of the most common supplements for digestive health.

Bloating, indigestion, and other gastrointestinal symptoms suggest that your gut health may benefit from extra support. While a healthy, whole foods diet is the foundation of a healthy gut, supplements can play an important role in restoring specific aspects of digestive function.

Digestive enzymes vs. probiotics: how do you choose the most appropriate supplement for your digestive issues? In this article, we’ll explore how probiotics and digestive enzymes work and help you choose the best product for you.

Digestive enzymes vs Probiotics: Two hands holding red and blue pills

What Are Digestive Enzymes?

Digestive enzymes are naturally produced by your body to help digest food. A variety of digestive enzymes break down different types of food in your digestive tract. This process ensures that your small intestine can extract nutrients from the food you eat.

Digestive enzymes are produced throughout the upper digestive tract and can be found in saliva, the stomach, and small intestine. The majority of digestive enzymes are produced by your pancreas.

Specific digestive enzymes play specific roles in digestion. Most digestive enzymes fall into one of three categories:

  • Amylase breaks down carbohydrates.
  • Protease breaks proteins down into amino acids.
  • Lipase breaks dietary fats down into fatty acids.
Illustration of different types of enzymes

A lack of specific enzymes makes certain types of food hard to digest. This can lead to food intolerances and nutrient deficiencies.

For example, if your body doesn’t produce enough lactase enzymes, you may become lactose intolerant. Diarrhea, gas, bloating, or cramping after consuming dairy products is a sign of lactose intolerance.

Over the long term, lactose intolerance can contribute to calcium deficiency and result in serious health consequences such as osteoporosis (low bone density) and hip fracture. Research suggests that the health consequences of lactose intolerance may mostly be the result of dairy avoidance (without adequate replacement of minerals found in dairy products) and that supplementation with a lactase enzyme can help to avoid these complications [1, 2].

What Are Probiotics?

Probiotics are live microorganisms that live in your digestive tract. They confer health benefits when consumed.

Your microbiome is the complex ecosystem of microorganisms that live in your digestive system. The live organisms in your microbiome perform critical functions for your digestion, hormonal health, nervous system, and immune function [3].

In a healthy gut, high levels of good bacteria keep bad bacteria in check, just as healthy plants keep weeds in check in a well-tended garden. However, if your gut health becomes unbalanced, unhealthy microbes can take over. Poor diet, antibiotics, overuse of antibacterial products, and many other factors can contribute to gut imbalances. Even lack of exercise and sleep can take a toll on your gut bacteria [4, 5].

An imbalance of microorganisms in your digestive system has far-reaching consequences for your health. Gut dysbiosis can lead to digestive symptoms and can also affect your energy levels, mood, hormonal health, immune health, metabolism, sleep, and much more.

The good bacteria in probiotics work by rebalancing the microorganisms in your gut [6, 7, 8], reducing overzealous immune system activity [9, 10], and reducing inflammation in your gut and throughout your body [11, 12].

Digestive Enzymes vs. Probiotics: How to Choose

Clearly, digestive enzymes and probiotics have different functions and health benefits. The supplement you choose depends on your current health symptoms and conditions.

When To Choose Digestive Enzymes

Digestive enzymes vs Probiotics: A woman refusing a glass of milk

If you have specific food intolerances, digestive enzymes may be very helpful. For example, you can try:

  • Lactase for dairy intolerance
  • Alpha galactosidase if beans and legumes make you gassy
  • DPP-IV for gluten intolerance (but not celiac disease)

Exocrine pancreatic insufficiency (EPI) is a condition that occurs when the pancreas stops producing normal enzyme levels. EPI can range from mild to severe enzyme deficiency. Milder cases of EPI often go undiagnosed while severe cases can cause life-threatening complications [13].

EPI is more common as you age and affects between 5% and 30% of people over the age of 70. Risk factors for EPI include [14]:

  • Pancreatic disorders such as chronic pancreatitis, autoimmune pancreatitis, and pancreatic tumors
  • Type 1 and 2 diabetes
  • Cystic fibrosis
  • Inflammatory bowel disease
  • Celiac disease
  • Sjorgen’s syndrome
  • Tobacco and alcohol use

EPI symptoms are similar to IBS and include diarrhea, abdominal pain, bloating, and gas. One study of IBS-D patients in the UK found that 6.1% of them had EPI [15]. If your digestive symptoms include stools that float and are foul-smelling or greasy, it’s important to get checked for EPI. Steatorrhea, or fatty stool, occurs when you don’t have sufficient enzymes for digesting dietary fats.

When To Choose Probiotics

In general, probiotic supplements treat a broader range of symptoms and conditions than digestive enzymes. That’s because imbalances in your gut microbiome cause chronic immune reactions and lead to inflammation in the gut and elsewhere in the body.

A significant body of research shows that probiotics are helpful for treating gut disorders, including:

  • IBS [16, 17, 18, 19, 20, 21]
  • SIBO (small intestinal bacterial overgrowth) [22, 23, 24, 25]
  • Leaky gut syndrome [26, 27, 28, 29, 30]
  • Bacterial, fungal, and parasitic gut infections [31, 32, 33, 34]
  • Crohn’s disease [35] and ulcerative colitis [36, 37, 38]
  • Constipation [39, 40, 41]
  • Antibiotic-associated diarrhea [42, 43, 44]

Supplementation with probiotics can also be helpful for symptoms that may be rooted in gut imbalances, including:

  • Depression [45, 46, 47] and anxiety [48, 49, 50, 51, 52, 53]. However, data is less conclusive that probiotics can help anxiety.
  • Symptoms of stress [54, 55, 56, 57]
  • Poor sleep quality [58, 59, 60, 61, 62]

Probiotics can also be helpful for bacterial infections outside the gut, including urinary tract infections [63], vaginal infections [64, 65], respiratory tract infections [66], gingivitis, and periodontal disease [67].

Finally, probiotics may be helpful for a number of other conditions, including skin conditions such as acne [68, 69] and dermatitis [70, 71], and seasonal allergies [72, 73, 74].

If You Are Not Sure Which To Take

Digestive enzymes vs Probiotics: A man with stomach pain

If you have digestive symptoms such as indigestion, bloating, or acid reflux, you may not be sure how to decide between digestive enzymes vs. probiotics.

In this case, it’s worth doing a separate trial of each supplement, starting with probiotics. For each type of supplement, take a full dose for 2-3 weeks and monitor your symptoms. If your symptoms improve, continue to take the supplement. If your symptoms don’t improve, there is no need to continue taking that supplement.

When To Take Both

If you have food intolerances, you may benefit from taking both probiotics and digestive enzymes. Research suggests that probiotics can help with lactose intolerance [75, 76, 77] and gluten intolerance [78, 79]. This is one reason why we recommend starting with probiotics and adding digestive enzymes, if you want to test both supplements.

One clinical trial involving post-infectious IBS patients noted changes in the small intestinal microbiome that resulted in lactase enzyme deficiency. After 14 days of probiotic supplementation, 70.8% of patients had resolved their gut dysbiosis and received normal scores on the lactase test [80].

It’s also worth noting that stomach acid helps stimulate your pancreas to release enzymes. If you have low stomach acid, Betaine HCl supplements can provide further help with digestion.

How To Take Digestive Enzyme Supplements

If you react to specific foods, look for specific types of enzymes in your supplement product. For example, if you are lactose intolerant, a lactase enzyme will be most helpful. If beans and legumes cause you excessive gas and abdominal pain, try using a product with alpha-galactosidase.

If you can’t connect your digestive symptoms with any specific food, it’s best to try a product that combines the most important enzymes that help you digest proteins, fats, and carbs.

Take digestive enzyme supplements before each meal, following the dosage guidelines on the product label. Allow 2-3 weeks of daily supplementation before deciding if digestive enzymes are helping to resolve your symptoms.

Digestive enzymes don’t usually cause side effects. However, protease enzyme supplements can be irritating for some. If you experience a burning sensation or increased bloating and gas right after taking digestive enzyme supplements, try a different formula.

How To Take Probiotic Supplements

One difference between digestive enzymes vs. probiotics: Probiotics don’t work like digestive enzymes, and there is no need to find the right strain for your health condition.

What you need to know is that almost all probiotic strains can be organized into one of these three categories:

CATEGORY 1CATEGORY 2CATEGORY 3
Lactobacillus & bifidobacterium species predominated blendsSaccharomyces Boulardii (a healthy fungus)Soil-Based Probiotics using various bacillus species
These are the most well-researched, with over 500 trials assessing their validity.  These live microorganisms are also known as lactic-acid producing probiotic bacteria.  They typically do not colonize the host but do improve the health of the host.The second most researched probiotic, with over 100 studies.  Saccharomyces boulardii (S. Boulardi for short) is not a normal part of human microbiota, meaning it does not colonize us but does improve the health of the host.The third most researched category of probiotics is soil-based probiotics. This group has roughly 14 clinical trials evaluating their effectiveness. This category is also known as spore-forming bacteria. This category of probiotic can colonize the host. [81]

The most effective approach for taking probiotics is to use one quality formula from each category and take them all together. Follow the full dosing schedule for 2-3 weeks, and then reevaluate your symptoms. If you are experiencing even a small improvement, keep going. If not, you can stop taking probiotic supplements and don’t need to try a different formula.

Research supports this approach to taking probiotics, finding multi-strain probiotics to be more effective than single-strain probiotics [82, 83, 84]. In my clinical experience, taking all three categories of probiotics together has made the difference between people experiencing minimal results or impressive results.

Digestive Enzymes and Probiotics From Food Sources

Digestive enzymes vs Probiotics: Fermented vegetables in jars

It’s possible to get both digestive enzymes and probiotics from food sources.

Many raw foods contain natural sources of enzymes which may be destroyed when heated. For example:

  • Papaya and papaya contain different proteases (papain and bromelain) which help in digesting protein [85, 86].
  • Raw honey contains several types of digestive enzymes

Probiotic lactic acid bacteria are found in fermented foods such as sauerkraut, kimchi, kefir, and kombucha) [87].

Including raw and fermented foods in your diet is a great idea. However, some people with digestive issues may have sensitivities to them. For example, fermented foods are not recommended for those with histamine intolerance.

Dietary supplements offer higher doses of probiotics and digestive enzymes than food sources. While food sources are great for a general maintenance diet, choose supplements if you are treating specific symptoms and conditions.

Digestive Enzymes vs. Probiotics: Two Great Options for Better Digestive Health

Probiotic supplements and digestive enzymes can effectively support your digestive health and overall wellness.

Choose digestive enzymes if you have specific food intolerances or one of the conditions associated with exocrine pancreatic insufficiency.

Choose probiotics if you have IBS, SIBO, or other types of gut imbalance. Probiotics can also be helpful for improving immune health, reducing inflammation, and resolving a wide variety of symptoms that result from gut dysbiosis.

If you have general digestive symptoms, a separate trial of each supplement can help you to determine which supplement will work best for you.

➕ References
  1. Szilagyi A, Ishayek N. Lactose Intolerance, Dairy Avoidance, and Treatment Options. Nutrients. 2018 Dec 15;10(12):1994. doi: 10.3390/nu10121994. PMID: 30558337; PMCID: PMC6316316.
  2. Hodges JK, Cao S, Cladis DP, Weaver CM. Lactose Intolerance and Bone Health: The Challenge of Ensuring Adequate Calcium Intake. Nutrients. 2019 Mar 28;11(4):718. doi: 10.3390/nu11040718. PMID: 30925689; PMCID: PMC6521087.
  3. Quigley EM. Gut bacteria in health and disease. Gastroenterol Hepatol (N Y). 2013 Sep;9(9):560-9. PMID: 24729765; PMCID: PMC3983973.
  4. Bressa C, Bailén-Andrino M, Pérez-Santiago J, González-Soltero R, Pérez M, Montalvo-Lominchar MG, Maté-Muñoz JL, Domínguez R, Moreno D, Larrosa M. Differences in gut microbiota profile between women with active lifestyle and sedentary women. PLoS One. 2017 Feb 10;12(2):e0171352. doi: 10.1371/journal.pone.0171352. PMID: 28187199; PMCID: PMC5302835.
  5. Smith RP, Easson C, Lyle SM, Kapoor R, Donnelly CP, Davidson EJ, Parikh E, Lopez JV, Tartar JL. Gut microbiome diversity is associated with sleep physiology in humans. PLoS One. 2019 Oct 7;14(10):e0222394. doi: 10.1371/journal.pone.0222394. PMID: 31589627; PMCID: PMC6779243.
  6. Leblhuber F, Steiner K, Schuetz B, Fuchs D, Gostner JM. Probiotic Supplementation in Patients with Alzheimer’s Dementia – An Explorative Intervention Study. Curr Alzheimer Res. 2018;15(12):1106-1113. doi: 10.2174/1389200219666180813144834. PMID: 30101706; PMCID: PMC6340155.
  7. Derrien M, van Hylckama Vlieg JE. Fate, activity, and impact of ingested bacteria within the human gut microbiota. Trends Microbiol. 2015 Jun;23(6):354-66. doi: 10.1016/j.tim.2015.03.002. Epub 2015 Apr 1. PMID: 25840765.
  8. Sanders ME. Impact of probiotics on colonizing microbiota of the gut. J Clin Gastroenterol. 2011 Nov;45 Suppl:S115-9. doi: 10.1097/MCG.0b013e318227414a. PMID: 21992949.
  9. Toribio-Mateas M. Harnessing the Power of Microbiome Assessment Tools as Part of Neuroprotective Nutrition and Lifestyle Medicine Interventions. Microorganisms. 2018 Apr 25;6(2):35. doi: 10.3390/microorganisms6020035. PMID: 29693607; PMCID: PMC6027349.
  10. Stenman LK, Lehtinen MJ, Meland N, Christensen JE, Yeung N, Saarinen MT, Courtney M, Burcelin R, Lähdeaho ML, Linros J, Apter D, Scheinin M, Kloster Smerud H, Rissanen A, Lahtinen S. Probiotic With or Without Fiber Controls Body Fat Mass, Associated With Serum Zonulin, in Overweight and Obese Adults-Randomized Controlled Trial. EBioMedicine. 2016 Nov;13:190-200. doi: 10.1016/j.ebiom.2016.10.036. Epub 2016 Oct 26. PMID: 27810310; PMCID: PMC5264483.
  11. Leblhuber F, Steiner K, Schuetz B, Fuchs D, Gostner JM. Probiotic Supplementation in Patients with Alzheimer’s Dementia – An Explorative Intervention Study. Curr Alzheimer Res. 2018;15(12):1106-1113. doi: 10.2174/1389200219666180813144834. PMID: 30101706; PMCID: PMC6340155.
  12. Hajifaraji M, Jahanjou F, Abbasalizadeh F, Aghamohammadzadeh N, Abbasi MM, Dolatkhah N. Effect of probiotic supplements in women with gestational diabetes mellitus on inflammation and oxidative stress biomarkers: a randomized clinical trial. Asia Pac J Clin Nutr. 2018;27(3):581-591. doi: 10.6133/apjcn.082017.03. PMID: 29737805.
  13. Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019 Mar 21;12:129-139. doi: 10.2147/CEG.S168266. PMID: 30962702; PMCID: PMC6432881.
  14. Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019 Mar 21;12:129-139. doi: 10.2147/CEG.S168266. PMID: 30962702; PMCID: PMC6432881.
  15. Leeds JS, Hopper AD, Sidhu R, Simmonette A, Azadbakht N, Hoggard N, Morley S, Sanders DS. Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency. Clin Gastroenterol Hepatol. 2010 May;8(5):433-8. doi: 10.1016/j.cgh.2009.09.032. Epub 2009 Oct 14. PMID: 19835990.
  16. Yuan F, Ni H, Asche CV, Kim M, Walayat S, Ren J. Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis. Curr Med Res Opin. 2017 Jul;33(7):1191-1197. doi: 10.1080/03007995.2017.1292230. Epub 2017 Mar 7. PMID: 28166427.
  17. Tiequn B, Guanqun C, Shuo Z. Therapeutic effects of Lactobacillus in treating irritable bowel syndrome: a meta-analysis. Intern Med. 2015;54(3):243-9. doi: 10.2169/internalmedicine.54.2710. PMID: 25748731.
  18. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008 May 7;14(17):2650-61. doi: 10.3748/wjg.14.2650. PMID: 18461650; PMCID: PMC2709042.
  19. Whelan K. Probiotics and prebiotics in the management of irritable bowel syndrome: a review of recent clinical trials and systematic reviews. Curr Opin Clin Nutr Metab Care. 2011 Nov;14(6):581-7. doi: 10.1097/MCO.0b013e32834b8082. PMID: 21892075.
  20. Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Moayyedi P. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547-61; quiz 1546, 1562. doi: 10.1038/ajg.2014.202. Epub 2014 Jul 29. PMID: 25070051.
  21. Martoni CJ, Srivastava S, Leyer GJ. Lactobacillus acidophilus DDS-1 and Bifidobacterium lactis UABla-12 Improve Abdominal Pain Severity and Symptomology in Irritable Bowel Syndrome: Randomized Controlled Trial. Nutrients. 2020 Jan 30;12(2):363. doi: 10.3390/nu12020363. PMID: 32019158; PMCID: PMC7071206.
  22. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017 Apr;51(4):300-311. doi: 10.1097/MCG.0000000000000814. PMID: 28267052.
  23. Soifer LO, Peralta D, Dima G, Besasso H. Eficacia comparativa de un probiótico vs un antibiótico en la respuesta clínica de pacientes con sobrecrecimiento bacteriano del intestino y distensión abdominal crónica funcional: un estudio piloto [Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study]. Acta Gastroenterol Latinoam. 2010 Dec;40(4):323-7. Spanish. PMID: 21381407.
  24. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017 Apr;51(4):300-311. doi: 10.1097/MCG.0000000000000814. PMID: 28267052.
  25. Leventogiannis K, Gkolfakis P, Spithakis G, Tsatali A, Pistiki A, Sioulas A, Giamarellos-Bourboulis EJ, Triantafyllou K. Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth. Probiotics Antimicrob Proteins. 2019 Jun;11(2):627-634. doi: 10.1007/s12602-018-9401-3. Erratum in: Probiotics Antimicrob Proteins. 2018 Mar 28;: PMID: 29508268; PMCID: PMC6541575.
  26. McFarlin BK, Henning AL, Bowman EM, Gary MA, Carbajal KM. Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers. World J Gastrointest Pathophysiol. 2017 Aug 15;8(3):117-126. doi: 10.4291/wjgp.v8.i3.117. PMID: 28868181; PMCID: PMC5561432.
  27. Sindhu KN, Sowmyanarayanan TV, Paul A, Babji S, Ajjampur SS, Priyadarshini S, Sarkar R, Balasubramanian KA, Wanke CA, Ward HD, Kang G. Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2014 Apr;58(8):1107-15. doi: 10.1093/cid/ciu065. Epub 2014 Feb 5. PMID: 24501384; PMCID: PMC3967829.
  28. Lamprecht M, Bogner S, Schippinger G, Steinbauer K, Fankhauser F, Hallstroem S, Schuetz B, Greilberger JF. Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. J Int Soc Sports Nutr. 2012 Sep 20;9(1):45. doi: 10.1186/1550-2783-9-45. PMID: 22992437; PMCID: PMC3465223.
  29. McFarlin BK, Henning AL, Bowman EM, Gary MA, Carbajal KM. Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers. World J Gastrointest Pathophysiol. 2017 Aug 15;8(3):117-126. doi: 10.4291/wjgp.v8.i3.117. PMID: 28868181; PMCID: PMC5561432.
  30. Mujagic Z, de Vos P, Boekschoten MV, Govers C, Pieters HH, de Wit NJ, Bron PA, Masclee AA, Troost FJ. The effects of Lactobacillus plantarum on small intestinal barrier function and mucosal gene transcription; a randomized double-blind placebo controlled trial. Sci Rep. 2017 Jan 3;7:40128. doi: 10.1038/srep40128. PMID: 28045137; PMCID: PMC5206730.
  31. Eslami M, Yousefi B, Kokhaei P, Jazayeri Moghadas A, Sadighi Moghadam B, Arabkari V, Niazi Z. Are probiotics useful for therapy of Helicobacter pylori diseases? Comp Immunol Microbiol Infect Dis. 2019 Jun;64:99-108. doi: 10.1016/j.cimid.2019.02.010. Epub 2019 Mar 5. PMID: 31174707.
  32. Demirel G, Celik IH, Erdeve O, Saygan S, Dilmen U, Canpolat FE. Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants. Eur J Pediatr. 2013 Oct;172(10):1321-6. doi: 10.1007/s00431-013-2041-4. Epub 2013 May 24. PMID: 23703468.
  33. Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA, Vandenplas Y. Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res. 2011 Mar;108(3):541-5. doi: 10.1007/s00436-010-2095-4. Epub 2010 Oct 5. PMID: 20922415.
  34. Besirbellioglu BA, Ulcay A, Can M, Erdem H, Tanyuksel M, Avci IY, Araz E, Pahsa A. Saccharomyces boulardii and infection due to Giardia lamblia. Scand J Infect Dis. 2006;38(6-7):479-81. doi: 10.1080/00365540600561769. PMID: 16798698.
  35. Hedin C, Whelan K, Lindsay JO. Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials. Proc Nutr Soc. 2007 Aug;66(3):307-15. doi: 10.1017/S0029665107005563. PMID: 17637082.
  36. Hedin C, Whelan K, Lindsay JO. Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials. Proc Nutr Soc. 2007 Aug;66(3):307-15. doi: 10.1017/S0029665107005563. PMID: 17637082.
  37. Kruis W, Fric P, Pokrotnieks J, Lukás M, Fixa B, Kascák M, Kamm MA, Weismueller J, Beglinger C, Stolte M, Wolff C, Schulze J. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut. 2004 Nov;53(11):1617-23. doi: 10.1136/gut.2003.037747. PMID: 15479682; PMCID: PMC1774300.
  38. Naidoo K, Gordon M, Fagbemi AO, Thomas AG, Akobeng AK. Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD007443. doi: 10.1002/14651858.CD007443.pub2. Update in: Cochrane Database Syst Rev. 2020 Mar 4;3:CD007443. PMID: 22161412.
  39. Wen Y, Li J, Long Q, Yue CC, He B, Tang XG. The efficacy and safety of probiotics for patients with constipation-predominant irritable bowel syndrome: A systematic review and meta-analysis based on seventeen randomized controlled trials. Int J Surg. 2020 Jul;79:111-119. doi: 10.1016/j.ijsu.2020.04.063. Epub 2020 May 6. PMID: 32387213.
  40. Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, Chen W. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020 Oct;39(10):2960-2969. doi: 10.1016/j.clnu.2020.01.005. Epub 2020 Jan 14. PMID: 32005532.
  41. Miller LE, Ouwehand AC, Ibarra A. Effects of probiotic-containing products on stool frequency and intestinal transit in constipated adults: systematic review and meta-analysis of randomized controlled trials. Ann Gastroenterol. 2017;30(6):629-639. doi: 10.20524/aog.2017.0192. Epub 2017 Sep 21. PMID: 29118557; PMCID: PMC5670282.
  42. Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, Johnsen B, Shekelle PG. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012 May 9;307(18):1959-69. doi: 10.1001/jama.2012.3507. PMID: 22570464.
  43. Blaabjerg S, Artzi DM, Aabenhus R. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients-A Systematic Review and Meta-Analysis. Antibiotics (Basel). 2017 Oct 12;6(4):21. doi: 10.3390/antibiotics6040021. PMID: 29023420; PMCID: PMC5745464.
  44. Cai J, Zhao C, Du Y, Zhang Y, Zhao M, Zhao Q. Comparative efficacy and tolerability of probiotics for antibiotic-associated diarrhea: Systematic review with network meta-analysis. United European Gastroenterol J. 2018 Mar;6(2):169-180. doi: 10.1177/2050640617736987. Epub 2017 Oct 4. PMID: 29511547; PMCID: PMC5833232.
  45. Ng QX, Peters C, Ho CYX, Lim DY, Yeo WS. A meta-analysis of the use of probiotics to alleviate depressive symptoms. J Affect Disord. 2018 Mar 1;228:13-19. doi: 10.1016/j.jad.2017.11.063. Epub 2017 Nov 16. PMID: 29197739.
  46. Huang R, Wang K, Hu J. Effect of Probiotics on Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2016 Aug 6;8(8):483. doi: 10.3390/nu8080483. PMID: 27509521; PMCID: PMC4997396.
  47. Akkasheh G, Kashani-Poor Z, Tajabadi-Ebrahimi M, Jafari P, Akbari H, Taghizadeh M, Memarzadeh MR, Asemi Z, Esmaillzadeh A. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition. 2016 Mar;32(3):315-20. doi: 10.1016/j.nut.2015.09.003. Epub 2015 Sep 28. PMID: 26706022.
  48. Yang BWei JJu P, et al
    Effects of regulating intestinal microbiota on anxiety symptoms: A systematic review
  49. Rao AV, Bested AC, Beaulne TM, Katzman MA, Iorio C, Berardi JM, Logan AC. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 2009 Mar 19;1(1):6. doi: 10.1186/1757-4749-1-6. PMID: 19338686; PMCID: PMC2664325.
  50. Liu B, He Y, Wang M, Liu J, Ju Y, Zhang Y, Liu T, Li L, Li Q. Efficacy of probiotics on anxiety-A meta-analysis of randomized controlled trials. Depress Anxiety. 2018 Oct;35(10):935-945. doi: 10.1002/da.22811. Epub 2018 Jul 11. PMID: 29995348.
  51. Liu RT, Walsh RFL, Sheehan AE. Prebiotics and probiotics for depression and anxiety: A systematic review and meta-analysis of controlled clinical trials. Neurosci Biobehav Rev. 2019 Jul;102:13-23. doi: 10.1016/j.neubiorev.2019.03.023. Epub 2019 Apr 17. PMID: 31004628; PMCID: PMC6584030.
  52. Reis DJ, Ilardi SS, Punt SEW. The anxiolytic effect of probiotics: A systematic review and meta-analysis of the clinical and preclinical literature. PLoS One. 2018 Jun 20;13(6):e0199041. doi: 10.1371/journal.pone.0199041. PMID: 29924822; PMCID: PMC6010276.
  53. McKean J, Naug H, Nikbakht E, Amiet B, Colson N. Probiotics and Subclinical Psychological Symptoms in Healthy Participants: A Systematic Review and Meta-Analysis. J Altern Complement Med. 2017 Apr;23(4):249-258. doi: 10.1089/acm.2016.0023. Epub 2016 Nov 14. PMID: 27841940.
  54. Messaoudi M, Violle N, Bisson JF, Desor D, Javelot H, Rougeot C. Beneficial psychological effects of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in healthy human volunteers. Gut Microbes. 2011 Jul-Aug;2(4):256-61. doi: 10.4161/gmic.2.4.16108. Epub 2011 Jul 1. PMID: 21983070.
  55. Allen AP, Hutch W, Borre YE, Kennedy PJ, Temko A, Boylan G, Murphy E, Cryan JF, Dinan TG, Clarke G. Bifidobacterium longum 1714 as a translational psychobiotic: modulation of stress, electrophysiology and neurocognition in healthy volunteers. Transl Psychiatry. 2016 Nov 1;6(11):e939. doi: 10.1038/tp.2016.191. PMID: 27801892; PMCID: PMC5314114.
  56. Kato-Kataoka A, Nishida K, Takada M, Kawai M, Kikuchi-Hayakawa H, Suda K, Ishikawa H, Gondo Y, Shimizu K, Matsuki T, Kushiro A, Hoshi R, Watanabe O, Igarashi T, Miyazaki K, Kuwano Y, Rokutan K. Fermented Milk Containing Lactobacillus casei Strain Shirota Preserves the Diversity of the Gut Microbiota and Relieves Abdominal Dysfunction in Healthy Medical Students Exposed to Academic Stress. Appl Environ Microbiol. 2016 May 31;82(12):3649-58. doi: 10.1128/AEM.04134-15. PMID: 27208120; PMCID: PMC4959178.
  57. Culpepper T, Christman MC, Nieves C Jr, Specht GJ, Rowe CC, Spaiser SJ, Ford AL, Dahl WJ, Girard SA, Langkamp-Henken B. Bifidobacterium bifidum R0071 decreases stress-associated diarrhoea-related symptoms and self-reported stress: a secondary analysis of a randomised trial. Benef Microbes. 2016 Jun;7(3):327-36. doi: 10.3920/BM2015.0156. Epub 2016 Feb 3. PMID: 26839075.
  58. Takada M, Nishida K, Gondo Y, Kikuchi-Hayakawa H, Ishikawa H, Suda K, Kawai M, Hoshi R, Kuwano Y, Miyazaki K, Rokutan K. Beneficial effects of Lactobacillus casei strain Shirota on academic stress-induced sleep disturbance in healthy adults: a double-blind, randomised, placebo-controlled trial. Benef Microbes. 2017 Apr 26;8(2):153-162. doi: 10.3920/BM2016.0150. PMID: 28443383.
  59. Marotta A, Sarno E, Del Casale A, Pane M, Mogna L, Amoruso A, Felis GE, Fiorio M. Effects of Probiotics on Cognitive Reactivity, Mood, and Sleep Quality. Front Psychiatry. 2019 Mar 27;10:164. doi: 10.3389/fpsyt.2019.00164. PMID: 30971965; PMCID: PMC6445894.
  60. Faghihi AH, Agah S, Masoudi M, Ghafoori SM, Eshraghi A. Efficacy of Probiotic Escherichia coli Nissle 1917 in Patients with Irritable Bowel Syndrome: a Double Blind Placebo-controlled Randomized Trial. Acta Med Indones. 2015 Jul;47(3):201-8. PMID: 26586385.
  61. Romijn AR, Rucklidge JJ, Kuijer RG, Frampton C. A double-blind, randomized, placebo-controlled trial of Lactobacillus helveticus and Bifidobacterium longum for the symptoms of depression. Aust N Z J Psychiatry. 2017 Aug;51(8):810-821. doi: 10.1177/0004867416686694. Epub 2017 Jan 10. PMID: 28068788; PMCID: PMC5518919.
  62. Nakakita Y, Tsuchimoto N, Takata Y, Nakamura T. Effect of dietary heat-killed Lactobacillus brevis SBC8803 (SBL88™) on sleep: a non-randomised, double blind, placebo-controlled, and crossover pilot study. Benef Microbes. 2016 Sep;7(4):501-9. doi: 10.3920/BM2015.0118. Epub 2016 Mar 25. PMID: 27013460.
  63. Falagas ME, Betsi GI, Tokas T, Athanasiou S. Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies. Drugs. 2006;66(9):1253-61. doi: 10.2165/00003495-200666090-00007. PMID: 16827601.
  64. Wang Z, He Y, Zheng Y. Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis. Int J Environ Res Public Health. 2019 Oct 12;16(20):3859. doi: 10.3390/ijerph16203859. PMID: 31614736; PMCID: PMC6848925.
  65. Hanson L, VandeVusse L, Jermé M, Abad CL, Safdar N. Probiotics for Treatment and Prevention of Urogenital Infections in Women: A Systematic Review. J Midwifery Womens Health. 2016 May;61(3):339-55. doi: 10.1111/jmwh.12472. PMID: 27218592.
  66. Wang Y, Li X, Ge T, Xiao Y, Liao Y, Cui Y, Zhang Y, Ho W, Yu G, Zhang T. Probiotics for prevention and treatment of respiratory tract infections in children: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016 Aug;95(31):e4509. doi: 10.1097/MD.0000000000004509. PMID: 27495104; PMCID: PMC4979858.
  67. Seminario-Amez M, López-López J, Estrugo-Devesa A, Ayuso-Montero R, Jané-Salas E. Probiotics and oral health: A systematic review. Med Oral Patol Oral Cir Bucal. 2017 May 1;22(3):e282-e288. doi: 10.4317/medoral.21494. PMID: 28390121; PMCID: PMC5432076.
  68. Kang BS, Seo JG, Lee GS, Kim JH, Kim SY, Han YW, Kang H, Kim HO, Rhee JH, Chung MJ, Park YM. Antimicrobial activity of enterocins from Enterococcus faecalis SL-5 against Propionibacterium acnes, the causative agent in acne vulgaris, and its therapeutic effect. J Microbiol. 2009 Feb;47(1):101-9. doi: 10.1007/s12275-008-0179-y. Epub 2009 Feb 20. PMID: 19229497.
  69. Muizzuddin N, Maher W, Sullivan M, Schnittger S, Mammone T. Physiological effect of a probiotic on skin. J Cosmet Sci. 2012 Nov-Dec;63(6):385-95. PMID: 23286870.
  70. Navarro-López V, Ramírez-Boscá A, Ramón-Vidal D, Ruzafa-Costas B, Genovés-Martínez S, Chenoll-Cuadros E, Carrión-Gutiérrez M, Horga de la Parte J, Prieto-Merino D, Codoñer-Cortés FM. Effect of Oral Administration of a Mixture of Probiotic Strains on SCORAD Index and Use of Topical Steroids in Young Patients With Moderate Atopic Dermatitis: A Randomized Clinical Trial. JAMA Dermatol. 2018 Jan 1;154(1):37-43. doi: 10.1001/jamadermatol.2017.3647. PMID: 29117309; PMCID: PMC5833582.
  71. Inoue Y, Kambara T, Murata N, Komori-Yamaguchi J, Matsukura S, Takahashi Y, Ikezawa Z, Aihara M. Effects of oral administration of Lactobacillus acidophilus L-92 on the symptoms and serum cytokines of atopic dermatitis in Japanese adults: a double-blind, randomized, clinical trial. Int Arch Allergy Immunol. 2014;165(4):247-54. doi: 10.1159/000369806. Epub 2015 Jan 31. PMID: 25660281.
  72. Güvenç IA, Muluk NB, Mutlu FŞ, Eşki E, Altıntoprak N, Oktemer T, Cingi C. Do probiotics have a role in the treatment of allergic rhinitis? A comprehensive systematic review and meta-analysis. Am J Rhinol Allergy. 2016 Sep 1;30(5):157-175. doi: 10.2500/ajra.2016.30.4354. Epub 2016 Jul 20. PMID: 27442711.
  73. Dennis-Wall JC, Culpepper T, Nieves C Jr, Rowe CC, Burns AM, Rusch CT, Federico A, Ukhanova M, Waugh S, Mai V, Christman MC, Langkamp-Henken B. Probiotics (Lactobacillus gasseri KS-13, Bifidobacterium bifidum G9-1, and Bifidobacterium longum MM-2) improve rhinoconjunctivitis-specific quality of life in individuals with seasonal allergies: a double-blind, placebo-controlled, randomized trial. Am J Clin Nutr. 2017 Mar;105(3):758-767. doi: 10.3945/ajcn.116.140012. Epub 2017 Feb 22. PMID: 28228426.
  74. Wang HT, Anvari S, Anagnostou K. The Role of Probiotics in Preventing Allergic Disease. Children (Basel). 2019 Feb 5;6(2):24. doi: 10.3390/children6020024. PMID: 30764558; PMCID: PMC6406271.
  75. Oak SJ, Jha R. The effects of probiotics in lactose intolerance: A systematic review. Crit Rev Food Sci Nutr. 2019;59(11):1675-1683. doi: 10.1080/10408398.2018.1425977. Epub 2018 Feb 9. PMID: 29425071.
  76. Szilagyi A, Ishayek N. Lactose Intolerance, Dairy Avoidance, and Treatment Options. Nutrients. 2018 Dec 15;10(12):1994. doi: 10.3390/nu10121994. PMID: 30558337; PMCID: PMC6316316.
  77. Almeida CC, Lorena SL, Pavan CR, Akasaka HM, Mesquita MA. Beneficial effects of long-term consumption of a probiotic combination of Lactobacillus casei Shirota and Bifidobacterium breve Yakult may persist after suspension of therapy in lactose-intolerant patients. Nutr Clin Pract. 2012 Apr;27(2):247-51. doi: 10.1177/0884533612440289. Epub 2012 Mar 8. PMID: 22402407.
  78. Di Pierro F, Bergomas F, Marraccini P, Ingenito MR, Ferrari L, Vigna L. Pilot study on non-celiac gluten sensitivity: effects of Bifidobacterium longum ES1 co-administered with a gluten-free diet. Minerva Gastroenterol Dietol. 2020 Sep;66(3):187-193. doi: 10.23736/S1121-421X.20.02673-2. Epub 2020 May 12. PMID: 32397695.
  79. Francavilla R, Piccolo M, Francavilla A, Polimeno L, Semeraro F, Cristofori F, Castellaneta S, Barone M, Indrio F, Gobbetti M, De Angelis M. Clinical and Microbiological Effect of a Multispecies Probiotic Supplementation in Celiac Patients With Persistent IBS-type Symptoms: A Randomized, Double-Blind, Placebo-controlled, Multicenter Trial. J Clin Gastroenterol. 2019 Mar;53(3):e117-e125. doi: 10.1097/MCG.0000000000001023. PMID: 29688915; PMCID: PMC6382041.
  80. Ruchkina IN, Fadeeva NA, Parfenov AI, Shcherbakov PL, Gubina AV, Poleva NI, Khomeriki SG, Chikunova BZ. [The role of small bowel microflora in the development of secondary lactase deficiency and the possibilities of its treatment with probiotics]. Ter Arkh. 2013;85(2):21-6. Russian. PMID: 23653934.
  81. Ilinskaya ON, Ulyanova VV, Yarullina DR, Gataullin IG. Secretome of Intestinal Bacilli: A Natural Guard against Pathologies. Front Microbiol. 2017 Sep 1;8:1666. doi: 10.3389/fmicb.2017.01666. PMID: 28919884; PMCID: PMC5586196.
  82. American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009 Jan;104 Suppl 1:S1-35. doi: 10.1038/ajg.2008.122. PMID: 19521341.
  83. Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Moayyedi P. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547-61; quiz 1546, 1562. doi: 10.1038/ajg.2014.202. Epub 2014 Jul 29. PMID: 25070051.
  84. Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, Chen W. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020 Oct;39(10):2960-2969. doi: 10.1016/j.clnu.2020.01.005. Epub 2020 Jan 14. PMID: 32005532.
  85. Pavan R, Jain S, Shraddha, Kumar A. Properties and therapeutic application of bromelain: a review. Biotechnol Res Int. 2012;2012:976203. doi: 10.1155/2012/976203. Epub 2012 Dec 10. PMID: 23304525; PMCID: PMC3529416.
  86. Muss C, Mosgoeller W, Endler T. Papaya preparation (Caricol®) in digestive disorders. Neuro Endocrinol Lett. 2013;34(1):38-46. PMID: 23524622.
  87. Dimidi E, Cox SR, Rossi M, Whelan K. Fermented Foods: Definitions and Characteristics, Impact on the Gut Microbiota and Effects on Gastrointestinal Health and Disease. Nutrients. 2019 Aug 5;11(8):1806. doi: 10.3390/nu11081806. PMID: 31387262; PMCID: PMC6723656.

Need help or would like to learn more?
View Dr. Ruscio’s, DC additional resources

Get Help

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!