Are Probiotic Drinks as Effective as Probiotic Supplements?

The Best Probiotic Drinks and Why You May Still Want to Take Your Probiotic Supplement 

• Probiotic Drinks vs. Supplements|
• Types of Probiotic Drinks|
• Health Benefits|
• Probiotic Drinks vs. Foods|
• Side Effects|
• The Bottom Line|

Probiotic drinks like fermented milks and fruit and vegetable juices are beverages that contain live cultures (aka beneficial strains of bacteria). These types of beverages have shown to improve gut microbiome balance, constipation, and diarrhea, as well as improve metabolic (insulin, blood sugar, and weight) and cardiovascular (cholesterol) parameters. But how do they compare to supplements or probiotic foods? 

While probiotic drinks do appear to be safe and beneficial, the viability of the probiotics (such as Bifidobacterium and Lactobacillus) contained in these beverages depends on a variety of important factors. So, if you’re looking for a therapeutic benefit, probiotic supplements are likely your best option.

In this article, we’ll discuss the different types of probiotic drinks, which ones may offer clinical benefits, and how processing and storage may impact their clinical usefulness. We’ll also take a look at how probiotic drinks compare to probiotic foods and supplements.

Probiotic Drinks vs. Probiotic Supplements

No research has made a direct comparison between the effectiveness of probiotic drinks and foods versus probiotic supplements [1]. A literature review found probiotic drinks, foods, and supplements to all be good probiotic delivery vehicles, but was unable to determine which was more effective [2].

One 2014 literature review did find probiotic capsules or tablets to be the most effective probiotic delivery system [3]. And a 2018 systematic review reported probiotics from enteric-coated capsules and freeze-dried capsules may be superior for delivering an effective dose of bacteria when compared to probiotic fermented milk (PFM) drinks [1].

A 2017 systematic review of randomized controlled trials did find probiotic supplements were not effective at reducing Clostridium difficile (C. diff)-associated diarrhea cases in elderly patients on antibiotic treatment, while a probiotic drink did significantly reduce the number of cases [4]. The probiotic drink may have been more effective than probiotic supplements in this case due to more bacterial strains or a different study design.

Types of Probiotic Drinks

You’ve likely heard of kefir and kombucha, but there are several probiotic drinks to choose from based on your personal preference and tolerance. 

The most common and well-studied probiotic beverages belong to the category of probiotic fermented milk (PFM). The fermented milk, kefir, and yogurt drinks in this group are made by adding active cultures to heat-treated animal milk, followed by incubation to lower the pH, with or without coagulation pretreatment [5].

Kombucha is the fastest-growing product in the functional beverage market and has been used for years in ancient cultures. It’s made by fermenting tea (black, green, or oolong) and sugar with a symbiotic culture of bacteria and yeast [6].

Less common probiotic drinks include fermented [7]:

• Fruit and vegetable drinks
• Legumes such as soymilk and chickpeas
• Cereals such as oat, rice, corn, and kwete (an alcoholic beverage)
• Pseudocereals such as quinoa, buckwheat, and amaranth

Health Benefits of Probiotic Drinks

Probiotic drinks that contain beneficial bacteria in sufficient amounts may provide a myriad of health benefits. 

One 2021 systematic review found fermented milk to provide beneficial effects with regard to cancer risk, type 2 diabetes mellitus, weight, and cardiovascular, bone, and gastrointestinal health [5]. Interestingly, despite its trending popularity, kombucha lacks clinical evidence to support its use for any specific health issue.

Let’s take a look at some of the research.

Gut Health

• Probiotic fermented milk (PFM) drinks have shown to significantly improve constipation, diarrhea, and antibiotic-associated diarrhea [8, 9], as well as improve stool formation and gut motility [10, 11].
• PFM drinks improve the balance of gut bacteria (gut microbiome) [9, 12].
• Fermented soymilk and kefir have shown to increase stool levels of healthy bacteria [13, 14].
• A 2019 randomized controlled trial found kefir consumption was associated with significant reductions in inflammation and bloating, along with an increase in quality of life for those with Crohn’s disease [14].

Cardiovascular Health 

• PFM consumption has been associated with a reduced risk of stroke, coronary artery disease, and death from cardiovascular disease [15], and significant improvements in LDL (low density lipoprotein) and total cholesterol levels [11, 16].
• Kefir consumption has also shown to improve cholesterol levels in overweight and obese women [17].

Metabolic Health 

• Kefir consumption has been associated with significant improvements in fasting blood sugar and insulin levels [18] as well as weight loss in overweight and obese women [17].
• A notable study on women with polycystic ovary syndrome (PCOS), who drank pomegranate juice with added probiotics and prebiotics for eight weeks (as well as those who drank a regular beverage with added prebiotics and probiotics), experienced significant improvements in insulin, insulin resistance, fasting blood sugar, and weight [19].

Immune System Health 

• The consumption of PFM and other fermented dairy products has been associated with a significant reduction in respiratory infections [20], as well as a reduced risk (in healthy people) of experiencing one or more common infectious diseases (like respiratory or gastrointestinal tract infections) [21].
• A 2013 randomized controlled trial found older adults who drank a PFM drink for four weeks had significantly greater natural killer-cell activity compared to when they started the study [22].
• A 2016 randomized controlled study found people who drank probiotic juice for eight weeks had a significant improvement in the symptoms of allergic rhinitis (inflammation of the mucous membrane of the nose), along with several immune markers associated with allergies [23].

Probiotic Drinks or Probiotic Foods: Which Is Better?

While no studies have shown probiotic drinks to be any more or less effective than probiotic foods (such as sauerkraut or kimchi), there are several factors to consider with these types of probiotic delivery systems.

• Live probiotics must be able to survive the harsh conditions of the stomach and adhere to the lining of the gut, as well as deliver a large enough number of viable bacteria to the small intestine and colon, to have a beneficial health effect [3, 7]. Notably, one 2017 literature review found the dosage of probiotics in food products in the Canadian food supply was too low to provide the benefits of probiotics seen in clinical trials [24].
• Factors such as the type of food used, storage, and processing can all affect the viability of a given probiotic food or drink [7].
• Dairy foods can be an effective delivery system for probiotic cultures, but for those with dairy allergies or intolerances and those who are vegan, this can be problematic [7].
• It’s difficult, but not impossible, to maintain the viability of probiotic strains in non-dairy foods. The addition of prebiotics to dairy-free foods and drinks can help increase the survival of probiotics [7].

Are There Side Effects to Probiotic Drinks?

Probiotics, whether from drinks, foods, or supplements are very safe [25]. The same (uncommon) side effects that may occur with probiotic supplements can exist with the consumption of probiotic drinks. 

Some possible side effects include [26]:

• Abdominal cramping
• Nausea
• Soft stools
• Gas
• Taste disturbances 

It’s also important to keep in mind, probiotic drinks may have a significant amount of added sugar or other additives that may cause inflammation, digestive system issues, and other negative side effects. In addition, dairy products containing probiotics may be a problem for people who are lactose intolerant or have a milk protein allergy [7].

For those who have histamine intolerance, fermented probiotic drinks may also be problematic, as fermentation produces histamine. Those who are sensitive to histamine or are following low-histamine diets should opt for probiotic supplements rather than probiotic drinks. 

While probiotics in general are extremely safe, there are a few instances to use caution [25]:

• Short gut syndrome
• Immunocompromised patients
• Elderly patients
• Critically ill infants or patients in the intensive care unit

But again, probiotics have been studied extensively, they’re safe, and they can be tolerated by most people.

Choose Probiotic Supplements for Clinical Benefit

Probiotic drinks are very safe, well-tolerated, and have the potential to provide some important health benefits. However, their clinical usefulness depends on many difficult-to-control variables and they may contain sugar and other inflammatory additives. 

If you want to take advantage of the myriad health benefits of probiotics, it’s probably best to use a high-quality probiotic supplement with many different strains and a high number of colony-forming units (CFUs).

To learn more about how to choose the best probiotic for you, check out Healthy Gut, Healthy You. For a more personalized plan, contact the Ruscio Institute for Functional Medicine.

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.