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.
Your Guide to All the Fundamentals of Taking Probiotics
How often should you take probiotics? The simple answer is daily (at a time that suits you).
Making probiotics a daily habit is more important than exactly when and how you consume them (e.g. with food or without).
Probiotics taken after a meal or on an empty stomach both improve gut health according to research.
You may need to take probiotics longer than you think — three months could be when the optimal benefits kick in.
You don’t need enteric-coated probiotics, and in fact, they may not be as effective.
Try more than one species or even category of probiotics (which can all be combined in one product) for the best effects.
There are all sorts of reasons you may decide to take probiotic supplements — from treating conditions like IBS and bloating, to reducing inflammation, improving brain fog, or boosting your microbiome.
Once you have taken this important step to support your digestive health, the next question is how often, and for how long, you should take probiotics, and whether there’s a preferred time of day to take them.
Since there are many opinions, and lots of people weighing in on these topics, I want to cut through the confusion and help you get some clarity here. We’ll look at what the research says and talk about what works best clinically too. You can also watch my video on the best way to take probiotics here.
Taking Probiotics Every Day is Best
Let’s start with the simplest instruction: take your probiotics daily (or at least most days).
There’s been lots of noise around probiotic dosage and frequency with different theories such as:
You shouldn’t take them for too long
You should rotate from one probiotic to another
Too many probiotics can cause overgrowths
You may even form a dependency
Thankfully, we have access to a robust meta-analysis that summarizes a lot of the available data on dosing with probiotics .
This large body of data shows us that in most studies with a positive outcome, probiotics were taken once or twice a day, sometimes for prolonged periods. Even in immunocompromised people, probiotics were found safe regardless of the strain, dosage and how long the person had been taking them.
None of the studies rotated probiotics or used any other more complicated dosing protocol.
One quick note, though: While it’s a good idea to take a daily probiotic, it’s also important not to stress out if you miss a day here or there. Just resume the next day.
Simply taking probiotics daily is adequate, ample, and efficacious.
Should You Take Probiotics With or Without Food?
As ever, there are many different theories floating around, which include:
Acid production stimulated by food in the stomach might kill probiotic bacteria, so you should take them on an empty stomach.
Probiotics need to be taken with certain prebiotic foods (foods that probiotics like to consume) to help them get down into the colon and thrive.
You should take an enteric-coated capsule of probiotic, so it is protected from stomach acid.
Actually, the research is pretty clear that none of the above contentions hold any weight. One study that divided participants into taking probiotics 30 minutes before a meal or 30 minutes after, found no difference in the beneficial effects, which included a substantial improvement in gut microbiota composition .
The best time of day to take your probiotics is the one that suits your own regimen the best. Remembering to take your probiotic and to do so consistently is what matters.
What some of the above theoretical concerns about timing of probiotic consumption also miss is that dead probiotics may actually be as effective as live probiotics. So the concept that we have to protect the probiotic from acid is likelye a moot point.
For example, a systematic review of 40 randomized clinical trials that compared heat-killed probiotics to the same living probiotic strain, found that dead probiotics were about as good as living probiotics for preventing and treating disease .
That’s not to say that you should be going out of your way to give your live probiotic a hard time surviving, but it does mean that it’s likely unimportant as to whether you take it with food or on an empty stomach.
Enteric Coated Probiotics Aren’t Necessary
I don’t generally recommend taking enteric-coated probiotics, which are designed to pass through the stomach undigested. With these formulations, only the large intestine can fully benefit from the probiotic, and your small intestine may not get much advantage at all (depending on exactly where the product begins to release in your gut).
Enteric-coated probiotics that don’t get to work in the small intestine might not be optimally effective in health conditions such as IBS, SIBO, autoimmune issues, and leaky gut, which all originate in this part of the gut.
How Long Should You Take Probiotics For?
Recent research has made me change my mind on the optimal length of time to be taking a probiotic.
A popular opinion used to be that if a probiotic isn’t improving your health after a month it probably isn’t going to work for you.
However, a meta-analysis of 43 randomized control trials shows this is not the case . After trawling through this research I found that the optimal duration when using probiotics for IBS symptoms was actually two to three months.
One specific study really piqued my interest. In this randomized control trial in constipated patients, half were given placebo, and half took a probiotic. The results showed that :
Both the probiotic and placebo groups showed minor improvement in symptoms up until about day 60.
It wasn’t until the third month that the improvement in the probiotic group really started to take off.
There might be various explanations for this but my take is that dysbiosis or methane SIBO are often underlying problems behind constipation and other gastrointestinal motility issues. Probiotics are perfectly able to remedy overgrowths of bacteria or an excess of methane in the small intestine, but it does take time. This is probably why we are seeing that a good couple of months are needed for benefit.
The Benefits Probiotics Can Offer
It pays to give probiotics a fair trial (3 months minimum) as the health benefits, though they might take a while to materialize, have been well-proven by a large amount of clinical research.
Probiotics can be beneficial `over a surprisingly wide spectrum of symptoms including:
The reason probiotics can have such wide-reaching effects is that they help to break the destructive cycle of inflammation and immune dysfunction in your gut.
An unhealthy balance of gut flora can lead to a poorly trained immune system and result in excessive inflammation. This inflammation can further damage the good bacteria in your intestinal tract, and damage your gut lining, creating a vicious circle.
Probiotics, in conjunction with a healthy diet, for example the Mediterranean diet or a Paleo-style diet, bring about the fundamental gut changes that can have such far reaching effects on all aspects of your health.
For example probiotics:
Increase the diversity of the living organisms in your digestive system, and bolster growth/numbers of healthier bacteria [18, 19].
Fight pathogenic microbes (harmful bacteria) and their toxins [14, 20, 21].
Promote a healthy immune system response in your gut [22, 23].
Reduce the gut inflammation that can be part of an overzealous immune response .
Reduce leaky gut, aka damage to your gut lining [25, 26].
The Three Main Types of Probiotic
While there are thousands of specific species and strains of probiotics, they mainly all fall under three types of healthy bacteria
Taking just one of the probiotic categories above can have good benefits. But in my clinical experience, the best probiotic regimen involves taking two of three of these categories together. The reason for this is likely because the combination does a better job at crowding out bad bacteria and keeping your gut microbiome healthy.
You can choose to take a probiotic product from one or more categories, or for extra convenience all three categories together in a combined triple therapy product.
Another way to round out your probiotic intake is to include some fermented foods such as kimchi, kefir, and kombucha in your healthy diet. These are not potent enough to take the place of a probiotic supplement, but they may be able to enhance the benefit.
Find A Probiotics Regimen That Suits You
In this article, I hope I’ve shown you that the intricacies of when and how often you should take probiotics isn’t really important. The main things that matter are:
Getting into the habit of taking them then every day at the most convenient time for you
Persisting with probiotic use for 2–3 months
For optimal benefit you may also want to consider taking more than one category of probiotics at a time and ideally all three (a Lactobacillus / Bifidobacterium blend, a beneficial yeast such as Saccharomycesboulardii, and a soil-based blend, e.g. Bacillus species).
Eating well and focusing on being consistent with probiotics can solve many gut-related issues and wider health problems. You can read more, including a step-by-step plan to revitalize your gut health in my book Healthy Gut, Healthy You. Or for a personal consultation, reach out to us at the Ruscio Institute of Functional Health.
The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.
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