There are several types of probiotic drinks, such as probiotic fermented milks and cereal drinks, kombucha, and fermented fruit and vegetable juices.
Studies comparing probiotic foods and drinks to probiotic supplements are lacking.
Probiotic capsules and tablets are likely superior to probiotic drinks when it comes to delivering a therapeutic dose of bacteria.
Probiotic drinks with adequate amounts of good bacteria may have benefits for digestive health, as well as immune, respiratory, and metabolic health.
Probiotic foods and drinks are likely similar when it comes to effectiveness.
Probiotic foods, drinks, and supplements are very safe for most people.
Fermented probiotic drinks may trigger symptoms for those with histamine intolerance.
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 Trusted SourcePubMedGo to source]. 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 Trusted SourcePubMedGo to source].
One 2014 literature review did find probiotic capsules or tablets to be the most effective probiotic delivery system [3 Trusted SourcePubMedGo to source]. 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 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source]. 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 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source]. Interestingly, despite its trending popularity, kombucha lacks clinical evidence to support its use for any specific health issue.
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 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source].
Immune System Health
The consumption of PFM and other fermented dairy products has been associated with a significant reduction in respiratory infections [20 Trusted SourcePubMedGo to source], as well as a reduced risk (in healthy people) of experiencing one or more common infectious diseases (like respiratory or gastrointestinal tract infections) [21 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source, 7 Trusted SourcePubMedGo to source]. 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 Trusted SourcePubMedGo to source].
Factors such as the type of food used, storage, and processing can all affect the viability of a given probiotic food or drink [7 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source].
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 Trusted SourcePubMedGo to source].
Are There Side Effects to Probiotic Drinks?
Probiotics, whether from drinks, foods, or supplements are very safe [25 Trusted SourcePubMedGo to source]. The same (uncommon) side effects that may occur with probiotic supplements can exist with the consumption of probiotic drinks.
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 Trusted SourcePubMedGo to source].
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.
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).
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.
Sniffen JC, McFarland LV, Evans CT, Goldstein EJC. Choosing an appropriate probiotic product for your patient: An evidence-based practical guide. PLoS ONE. 2018 Dec 26;13(12):e0209205. DOI: 10.1371/journal.pone.0209205. PMID: 30586435. PMCID: PMC6306248. Trusted SourcePubMedGo to source
Homayoni Rad A, Vaghef Mehrabany E, Alipoor B, Vaghef Mehrabany L. The comparison of food and supplement as probiotic delivery vehicles. Crit Rev Food Sci Nutr. 2016;56(6):896–909. DOI: 10.1080/10408398.2012.733894. PMID: 25117939. Trusted SourcePubMedGo to source
Govender M, Choonara YE, Kumar P, du Toit LC, van Vuuren S, Pillay V. A review of the advancements in probiotic delivery: Conventional vs. non-conventional formulations for intestinal flora supplementation. AAPS PharmSciTech. 2014 Feb;15(1):29–43. DOI: 10.1208/s12249-013-0027-1. PMID: 24222267. PMCID: PMC3909163. Trusted SourcePubMedGo to source
Vernaya M, McAdam J, Hampton MD. Effectiveness of probiotics in reducing the incidence of Clostridium difficile-associated diarrhea in elderly patients: a systematic review. JBI Database System Rev Implement Rep. 2017 Jan;15(1):140–64. DOI: 10.11124/JBISRIR-2016-003234. PMID: 28085732. Trusted SourcePubMedGo to source
Kapp JM, Sumner W. Kombucha: a systematic review of the empirical evidence of human health benefit. Ann Epidemiol. 2019 Feb;30:66–70. DOI: 10.1016/j.annepidem.2018.11.001. PMID: 30527803. Trusted SourcePubMedGo to source
Valero-Cases E, Cerdá-Bernad D, Pastor J-J, Frutos M-J. Non-Dairy Fermented Beverages as Potential Carriers to Ensure Probiotics, Prebiotics, and Bioactive Compounds Arrival to the Gut and Their Health Benefits. Nutrients. 2020 Jun 3;12(6). DOI: 10.3390/nu12061666. PMID: 32503276. PMCID: PMC7352914. Trusted SourcePubMedGo to source
Wong S, Jamous A, O’Driscoll J, Sekhar R, Weldon M, Yau CY, et al. A Lactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries: a randomised controlled trial. Br J Nutr. 2014 Feb;111(4):672–8. DOI: 10.1017/S0007114513002973. PMID: 24044687. Trusted SourcePubMedGo to source
Aoki T, Asahara T, Matsumoto K, Takada T, Chonan O, Nakamori K, et al. Effects of the continuous intake of a milk drink containing Lactobacillus casei strain Shirota on abdominal symptoms, fecal microbiota, and metabolites in gastrectomized subjects. Scand J Gastroenterol. 2014 May;49(5):552–63. DOI: 10.3109/00365521.2013.848469. PMID: 24621348. Trusted SourcePubMedGo to source
Moreira TR, Leonhardt D, Conde SR. Influence of drinking a probiotic fermented milk beverage containing bifidobacterium animalis on the symptoms of constipation. Arq Gastroenterol. 2017 May 25;54(3):206–10. DOI: 10.1590/S0004-2803.201700000-27. PMID: 28591244. Trusted SourcePubMedGo to source
Chiu H-F, Fang C-Y, Shen Y-C, Venkatakrishnan K, Wang C-K. Efficacy of Probiotic Milk Formula on Blood Lipid and Intestinal Function in Mild Hypercholesterolemic Volunteers: A Placebo-control, Randomized Clinical Trial. Probiotics Antimicrob Proteins. 2021 Jun;13(3):624–32. DOI: 10.1007/s12602-020-09728-6. PMID: 33404865. Trusted SourcePubMedGo to source
Nagata S, Asahara T, Wang C, Suyama Y, Chonan O, Takano K, et al. The Effectiveness of Lactobacillus Beverages in Controlling Infections among the Residents of an Aged Care Facility: A Randomized Placebo-Controlled Double-Blind Trial. Ann Nutr Metab. 2016;68(1):51–9. DOI: 10.1159/000442305. PMID: 26599038. Trusted SourcePubMedGo to source
Nagino T, Kaga C, Kano M, Masuoka N, Anbe M, Moriyama K, et al. Effects of fermented soymilk with Lactobacillus casei Shirota on skin condition and the gut microbiota: a randomised clinical pilot trial. Benef Microbes. 2018 Feb 27;9(2):209–18. DOI: 10.3920/BM2017.0091. PMID: 29264969. Trusted SourcePubMedGo to source
Yılmaz İ, Dolar ME, Özpınar H. Effect of administering kefir on the changes in fecal microbiota and symptoms of inflammatory bowel disease: A randomized controlled trial. Turk J Gastroenterol. 2019 Mar;30(3):242–53. DOI: 10.5152/tjg.2018.18227. PMID: 30662004. PMCID: PMC6428516. Trusted SourcePubMedGo to source
Companys J, Pla-Pagà L, Calderón-Pérez L, Llauradó E, Solà R, Pedret A, et al. Fermented Dairy Products, Probiotic Supplementation, and Cardiometabolic Diseases: A Systematic Review and Meta-analysis. Adv Nutr. 2020 Jul 1;11(4):834–63. DOI: 10.1093/advances/nmaa030. PMID: 32277831. PMCID: PMC7360468. Trusted SourcePubMedGo to source
Ziaei R, Ghavami A, Khalesi S, Ghiasvand R, Mokari Yamchi A. The effect of probiotic fermented milk products on blood lipid concentrations: A systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2021 Apr 9;31(4):997–1015. DOI: 10.1016/j.numecd.2020.12.023. PMID: 33612379. Trusted SourcePubMedGo to source
Fathi Y, Ghodrati N, Zibaeenezhad M-J, Faghih S. Kefir drink causes a significant yet similar improvement in serum lipid profile, compared with low-fat milk, in a dairy-rich diet in overweight or obese premenopausal women: A randomized controlled trial. J Clin Lipidol. 2017;11(1):136–46. DOI: 10.1016/j.jacl.2016.10.016. PMID: 28391880. Trusted SourcePubMedGo to source
Salari A, Ghodrat S, Gheflati A, Jarahi L, Hashemi M, Afshari A. Effect of kefir beverage consumption on glycemic control: A systematic review and meta-analysis of randomized controlled clinical trials. Complement Ther Clin Pract. 2021 Aug;44:101443. DOI: 10.1016/j.ctcp.2021.101443. PMID: 34280689. Trusted SourcePubMedGo to source
Esmaeilinezhad Z, Babajafari S, Sohrabi Z, Eskandari MH, Amooee S, Barati-Boldaji R. Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: A randomized, triple blind, controlled trial. Nutr Metab Cardiovasc Dis. 2019 Feb;29(2):201–8. DOI: 10.1016/j.numecd.2018.07.002. PMID: 30538082. Trusted SourcePubMedGo to source
Rashidi K, Razi B, Darand M, Dehghani A, Janmohammadi P, Alizadeh S. Effect of probiotic fermented dairy products on incidence of respiratory tract infections: a systematic review and meta-analysis of randomized clinical trials. Nutr J. 2021 Jun 28;20(1):61. DOI: 10.1186/s12937-021-00718-0. PMID: 34183001. PMCID: PMC8240278. Trusted SourcePubMedGo to source
Poon T, Juana J, Noori D, Jeansen S, Pierucci-Lagha A, Musa-Veloso K. Effects of a Fermented Dairy Drink Containing Lacticaseibacillus paracasei subsp. paracasei CNCM I-1518 (Lactobacillus casei CNCM I-1518) and the Standard Yogurt Cultures on the Incidence, Duration, and Severity of Common Infectious Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020 Nov 10;12(11). DOI: 10.3390/nu12113443. PMID: 33182682. PMCID: PMC7698120. Trusted SourcePubMedGo to source
Dong H, Rowland I, Thomas LV, Yaqoob P. Immunomodulatory effects of a probiotic drink containing Lactobacillus casei Shirota in healthy older volunteers. Eur J Nutr. 2013 Dec;52(8):1853–63. DOI: 10.1007/s00394-012-0487-1. PMID: 23307112. Trusted SourcePubMedGo to source
Harima-Mizusawa N, Kano M, Nozaki D, Nonaka C, Miyazaki K, Enomoto T. Citrus juice fermented with Lactobacillus plantarum YIT 0132 alleviates symptoms of perennial allergic rhinitis in a double-blind, placebo-controlled trial. Benef Microbes. 2016 Nov 30;7(5):649–58. DOI: 10.3920/BM2016.0003. PMID: 27633173. Trusted SourcePubMedGo to source
Scourboutakos MJ, Franco-Arellano B, Murphy SA, Norsen S, Comelli EM, L’Abbé MR. Mismatch between Probiotic Benefits in Trials versus Food Products. Nutrients. 2017 Apr 19;9(4). DOI: 10.3390/nu9040400. PMID: 28422059. PMCID: PMC5409739. Trusted SourcePubMedGo to source
Didari T, Solki S, Mozaffari S, Nikfar S, Abdollahi M. A systematic review of the safety of probiotics. Expert Opin Drug Saf. 2014 Feb;13(2):227–39. DOI: 10.1517/14740338.2014.872627. PMID: 24405164. Trusted SourcePubMedGo to source
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!
Transform your health
Every product is science-based, validated by real-world use, and personally vetted by Dr. Ruscio, DNM, DC.