Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
Restoring the Gut Microbiota Takes Time, and Just How Long May Depend on the Shape of Your Gut Health
For most, it’s best to trial probiotics for at least 3 months, however, there are some conditions where probiotics work much more quickly, or much more slowly.
To better reduce symptoms, it’s a good idea to remove any dietary triggers during your probiotic trial with a type of elimination-style diet.
To ensure probiotic success, it’s important to pick a high-quality probiotic.
Using triple therapy probiotics is a great way to ensure you see benefit, but it isn’t always required.
If you’re starting a course of probiotics, it helps to have realistic expectations about how quickly they will start working. You don’t want to give up on your probiotic supplements before they’ve had a chance to improve your well-being. You also don’t want to waste money taking probiotic products that don’t have any health benefits for you.
Based on my observation in the clinic, some patients notice the benefits of probiotics as soon as 1–3 days. For others, it takes as long as 8 weeks to see the effects of probiotic supplementation. However, more recent research suggests trialing a minimum of 3 months on probiotics before you can see significant improvements to your gut microbiome and, in turn, overall health.
So let’s look at how quickly probiotics work for some common health conditions, exactly how this “good bacteria” works to restore the gut, and how to make the right choice in selecting a quality probiotic.
The Timeline for Probiotic Benefits for Digestive Issues & Beyond
Hundreds of studies show the benefits of probiotics for a wide variety of medical conditions, including digestive problems (like IBS, bloating, and Crohn’s disease) as well as several non-digestive symptoms and conditions. Unfortunately, most studies don’t collect daily symptom data. That means that, for most studies, we know that probiotic supplementation was effective, but we don’t know how quickly it worked.
However, more recent studies can give us insight into expectations you can have for how long of a duration will provide benefit. These recent studies have even changed my understanding of how long a probiotic trial should be.
For example, we already know that probiotics can help irritable bowel syndrome (IBS). That’s because, for IBS and many other medical conditions, probiotics work by restoring balance in your gut bacteria, and addressing the root cause of symptoms.
I previously believed anywhere from 1–8 weeks to be sufficient, based on previous data and my clinical experience. But a recent meta-analysis suggests a trial of 2–3 months may be best to see benefit for IBS symptoms. So while I wasn’t far off, it shows that it may be worth sticking it out for longer than we previously thought.
Let’s go over a snapshot of different probiotic timeframes depending on your condition.
It’s important to note that the timeframe for seeing benefits is the minimum duration, meaning it may take up until that point to see health benefits. It does not mean that’s when you should stop taking probiotics. If you’re seeing benefits, it’s likely worth sticking with probiotics. (But we’ll discuss if, when, and how to cut back on the dosage a little later.):
Though it may take up to 3 months to see the most probiotic payoff, research shows that probiotics work in as little as 1–5 days for acute diarrhea.[1, 2, 3, 4] This is great news if you come down with a case of traveler’s diarrhea (and serves as a reminder to pack your probiotics in case you start experiencing any off bowel movements on your next trip.)
And, of course, as with any supplements, there are some who experience great results sooner due to what is referred to as the placebo effect. In other words, by expecting and believing that the probiotic will work, they experience beneficial effects. Our thoughts are powerful.
Probiotic Payoff: Later for Food Intolerance
Preliminary research shows that probiotics can be helpful in reducing dairy intolerance. However, it can take anywhere from 6 months to 3 years.
This study corresponds with what I have seen in my clinical practice. As patients improve their gut health, bloating, fatigue, mood, and many other symptoms can start to abate fairly quickly. However, food intolerances do often persist much longer. The good news, as I have seen many times, is that as gut health improves, food intolerances often do diminish over time.
Give Probiotics a Helping Hand By Also Removing Dietary Triggers
In addition to taking probiotics, it can be very helpful to identify and eliminate foods that trigger symptoms. Removing foods that cause inflammation can help abate any existing gut dysbiosis (or imbalance) and allow probiotics to do a better job colonizing the gut.
There are several elimination-style diets on offer, like the low FODMAP diet or Paleo diet, that are designed to help you identify food intolerances and are excellent tools for improving your gut health. And while it’s important to avoid foods that trigger reactions, these diets are meant to be short-term. It’s important to gradually reintroduce foods and broaden your diet as much as possible over time so that you can have as little dietary restriction as possible.
It can take some trial and error, and it isn’t always a linear process. You may test a food item several times and continue to react and then suddenly you find you are able to tolerate it in moderate quantities. Fortunately, based on the research so far, long-term probiotic supplementation is likely to support this process.
Bottom Line: For most conditions, take probiotics for at least 3 months to see if they work for you. Acute diarrhea and food intolerances are exceptions to these guidelines.
How Probiotics Work
Now that we’ve answered the question of “how quickly do probiotics work?”, it’s important to understand why.
Probiotics, to put it simply, are beneficial bacteria that colonize your gut by crowding out bad bacteria. They help balance your gut flora and reduce the burden of pathogenic microorganisms. As the bacteria in your gastrointestinal tract become more balanced, the immune system calms, inflammation reduces, and your digestive health improves.
But it doesn’t stop there. Once your gut is balanced and inflammation reduced, your overall well-being (energy, mood, cognition, immune health, hormonal balance) also improves.
This process explains why it takes time for probiotics to work. It also explains why probiotics have so many different health benefits and few side effects. Research shows the benefits of probiotics for a wide variety of medical conditions, including IBS, Crohn’s disease and colitis, gut infections, mood, sleep, thyroid health, and more.
For a science-based list of medical conditions that benefit from probiotic supplementation, see my Probiotic Starter Guide.
It’s important to note, however, that while getting any amount of probiotics is a good idea, there’s a pretty large difference between getting probiotics as a dietary supplement or eating probiotic foods. Probiotics are measured in “colony forming units” or CFUs, and fermented foods like kimchi or sauerkraut or drinks like kombucha don’t contain as high of CFUs as supplements. Not to mention you’d have to eat them consistently, every day, to maintain a therapeutic dose.
How to Know If a Probiotic Works For You
Probiotics work well for many medical conditions, but they’re not a panacea that’s guaranteed to work for everyone.
I recommend a trial of 3 months to test their effectiveness for you, even if you’ve tried probiotics before. But it’s important that you do a full and complete trial and follow a few guidelines.
Get It Right in One Go
A lot of people try probiotic supplements without really knowing which probiotic strains to buy or how long to take supplements. They may go on and off probiotic products, trying different brands or different strains of probiotics, hoping for better results. They also may not be informed about selecting a high-quality probiotic supplement.
I call this the probiotics merry-go-round and it can be a waste of time, energy, and money.
Here is some simple advice for implementing an effective probiotic trial.
Select a High-Quality Probiotic Supplement
The Food and Drug Administration (FDA) doesn’t actually review the quality of probiotics and research shows that some probiotic supplements are not worth buying.
The two most common reasons probiotic products don’t work are:
1) Not meeting label claims
2) Containing potentially harmful organisms
Here’s what the research shows:
Of 26 commercial probiotics assessed in this study, none fully supported label claims, and some of them contained unacceptable microorganisms .
One study found only half of the probiotics examined had the specific probiotic strain listed on the label .
Another study found only 27% of probiotic products had the amount of healthy bacteria listed on their labels .
You don’t need to purchase the most expensive probiotic supplements. But, you should be wary of a probiotic product that is substantially cheaper than the rest. This usually indicates corners have been cut in the quality assurance measures.
For specific information on what you should look for in a high-quality probiotic supplement, see my Probiotic Starter Guide.
Select the Right Probiotic Strains
There are a lot of different probiotic strains, but all you really need to know are the three main probiotic categories. Nearly every probiotic product can be classified into one of these categories:
These are the most well-researched, with over 500 trials assessing their validity. These live beneficial bacteria 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. boulardii for short) is not a normal part of human microbiota, meaning it does not colonize us but does improve the health and well-being 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 probiotics can colonize the host.
This is great news. This means you don’t need to try every probiotic strain on the market—simply pick one high-quality probiotic product from each category.
You also don’t need to match specific probiotic strains to specific medical conditions. Research shows that all strains of probiotics work in a similar way by addressing the health of your digestive system and can provide benefit. One category of probiotics may be more effective for you than another because of the unique profile of gut flora in your intestinal tract, but you’ll likely see benefit no matter the category you choose.
A great way to ensure you’ll get benefit or that you’re taking the best category for your needs is simple—take them all. This is what I refer to as the “triple therapy” approach, which gives you full exposure to all 3 categories of probiotic bacteria. This approach can be very effective for those who have had poor results with a more haphazard approach to choosing probiotic strains. To do a triple therapy protocol, you can either take a dose from each separate probiotic type, or you can simply take one of my triple therapy powder sticks. I formulated the powder sticks for the exact purpose of making the triple therapy approach easier.
As we discussed above, it’s a good idea to start by taking all three probiotic strains together for a trial period of at least 3 months.
How to Monitor the Effectiveness of Your Probiotic Supplements
When improvements to your well-being are gradual, they are sometimes easy to overlook. Keeping a written record of symptoms can be very helpful.
Here’s an approach that will help you to be as objective as possible in monitoring the effects of probiotics during your trial:
1st – Take stock of your symptoms
They might be fatigue and depression, bloating, joint pain, constipation, or insomnia. Whatever they are, take stock of how frequent and how severe your symptoms are.
2nd – Reevaluate
Check in with yourself and ask, “Are my symptoms improving?” If so, keep on the probiotic protocol. Remember, you are not looking for complete resolution, rather a clear trend of improvement. If that’s the case, great, we are on the right track. Keep going.
3rd – Look for when you hit your peak improvement
Once you peak or plateau, great. This is another milestone. Keep this constant for another four weeks, so your body can integrate and you can lock in this new level of good health.
After four weeks…
4th – Find your minimal effective dose
Technically, you don’t have to do this, but I find less is more with supplements. I like people to cut their dose of probiotic supplements in half, then reevaluate after 3–4 weeks. If this goes well, try cutting it in half again. If you get to a point where you start to experience symptoms again, then go back to the previous dose you were taking—that’s your “minimal effective dose”.
There is no one right way of weaning off your probiotic dose. You may want to try a different method. If, at some point, your symptoms return, it means you should stay on the probiotics. You can try weaning again in a few months.
Probiotics can safely be used in the long term, so if you consistently notice you feel better on them, that is OK.
If Symptoms Return
You can be going along great, and then something derails your gut health. Things like travel, stress, or a significant period of poor self-care might lead to a regression. It’s OK, life happens. Don’t be hard on yourself. Simply return to the full Probiotic Triple Therapy protocol, and then later, you can again wean your dose.
What to Do if Probiotics Aren’t Working
If you have been taking a high-quality probiotic supplement and following the Probiotic Triple Therapy protocol for 3 months, and you don’t experience any change in symptoms, you can be confident that you don’t need to try another probiotic product.
With probiotics, you have laid an important foundation that can make other, subsequent, gut therapies more effective. For example, some people have stubborn imbalances in their intestinal bacteria that may require more than probiotics. Antibacterial treatments like herbs or even select antibiotics can help here. Studies have found that probiotics make antibacterial treatments more effective. So we start with probiotics and then consider additional support if needed.
Probiotic Proof Takes Time
While probiotics can be helpful for a wide range of conditions, there’s also a wide window for seeing probiotic payoff. You can feel symptom relief in a matter of days for conditions like diarrhea, to needing 6 months to really feel the full effects for more stubborn issues. However, a good rule of thumb is to keep up a probiotic protocol for 3 months.
By also removing foods that cause inflammation you can help probiotics to do a better job colonizing the gut. Elimination-style diets like the Paleo diet or low FODMAP are good short-term diets to use when starting a gut-healing protocol with probiotics. Eventually, you should be able to reintroduce foods and find your minimum effective probiotic dose, so that you can have the most gut-healthy, and least restrictive regimen possible.
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