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.
While not much research can tell us exactly what happens when you stop taking probiotics, there is some available evidence that can be used alongside your personal experience to help you make a decision. Let’s explore the possible effects of stopping probiotics and how to determine your lowest effective dose.
What Happens When You Stop Taking Probiotics?
So, after having taken probiotics for a while, you’re feeling good and decide that the time has come to stop. Now what? Do you have to continue with large amounts of probiotic supplementation indefinitely? The answer is this is an emerging area without a lot of hard science available. With that in mind, here are a few factors to consider.
Probiotics Are Safe to Take (and to Discontinue)
Some may wonder about possible safety concerns associated with long-term use of a supplement. The good news is probiotics are not likely to cause harm over the long term.
While there haven’t been any long-term studies yet, numerous studies and reviews have found probiotics to be safe for adults, children, and infants. Even for immunocompromised adults, probiotics appear to be safe . When researchers analyzed results from 57 clinical studies in which probiotics were administered to immunocompromised individuals, they were also found to be safe . It didn’t matter what the dosage was, which probiotic strains were used, or how long the person had been taking these.
What’s more, probiotics have also been found to be safe for healthy infants, a systematic review shows . This included six different probiotics in a variety of studies, none of which had any adverse reactions or safety concerns.
A 2015 report points out that for over 100 years, probiotics have been used safely in foods and dairy products .
People have been eating probiotic foods such as sauerkraut, kimchi, kefir, and kombucha for over a century without issues.
Still, while the overwhelming majority of evidence including the history of use and data from clinical trials all support the idea that probiotics are safe for most people, there are some theoretical risks. These include the potential for infections, too much immune stimulation in susceptible patients, the possibility of interfering with metabolic activities, and a possibility for transfer of antibiotic resistance . But for most people, especially for those who have been successfully using probiotics for a while, side effects are not an issue.
When it comes to discontinuing probiotics, some have theorized that abruptly suspending use of probiotics could potentially increase vulnerability to infection. In one animal study, over a 14-day period, tilapias were fed a probiotic supplement diet that included a strain of Lactobacillus plantarum. When this was abruptly stopped, the tilapias became susceptible to the harmful A. hydrophila bacteria.
This model was used to mimic what might happen in patients who are immunocompromised, but it does show that there may be increased risk of infection for some if probiotics are abruptly stopped. But the fact is research indicates that this is probably most relevant for those with certain health conditions who are immunocompromised or for newborn babies who are at greater risk of opportunistic infections if this affects humans at all .
Probiotics May Only Colonize the Gut Temporarily
Research does suggest that probiotics only colonize the gut temporarily .
So, if you stop taking probiotics, the levels of different kinds of bacteria in your gut microbiome are likely to return to what they were before. For example, in one trial, participants were given supplements of the probiotic strain Lactobacillus rhamnosus DR20. In 6 out of 10 patients, this became the dominant strain in the population of lactobacilli during the six-month test period.
But two months after stopping treatment, this strain was present in only 1 out of 20 patients in the fecal microflora .
Listen To Your Body
Keep in mind that although your gut microbiome may return to its original state after discontinuing probiotics, this most likely won’t be an instant change. If for some reason you forget to take your probiotics for several days or weeks, though, you might start to notice a difference.
This is the important takeaway: The actual makeup of your gut microbiome a month after going off probiotics doesn’t matter nearly as much as how you feel. Some people will continue to feel great while others over a few months may begin to notice a difference.
While there may not be much in the literature about taking people off probiotics, we have seen this often in the clinic. We use probiotics with nearly all of our patients. What we have found is that for some, completely coming off probiotics once benefits have plateaued is no problem. Some continue to feel just as good when they’re off the probiotics as when they’re on them.
What Happened When I Stopped Taking Probiotics
However, this is not true for everyone. In fact, I personally had some trouble when I came off the probiotics I had been taking. While I didn’t notice any immediate change, after a couple of months I found I was experiencing more bloating after some meals, as well as some brain fog as a reaction to certain foods.
It didn’t register at first that the connection was going off the probiotics. But then, I realized that I had stopped taking these a month or two earlier. So, I went back to taking these and within a few weeks I found I was feeling good again.
But going off of these cold turkey for a while was something that I needed to do. This allowed me to see how I felt and to understand that I still needed the probiotics somewhat. The idea is if we do see a difference (i.e., symptoms return), we can restart the probiotics and gradually reduce the dose. After normalizing my gut bacteria again, I figured out the dose I needed to feel like I had been before going off the probiotics. In short, I used a stepwise approach that has also helped my patients. I’ll detail this approach a little further down.
How to Determine Your Lowest Effective Dose of Probiotics
Here’s a step-by-step guide to determining whether you should continue probiotics (and at what dose) once your health has improved.
Go off your probiotics completely. If you continue to feel good, no further steps are needed.
If symptoms return, resume probiotic use. If you’re not feeling your best, go back on the probiotics until you feel good again.
Cut your dose of probiotics in half. Once you’re feeling good again, start taking a half dose and see how you feel after a few weeks.
If you feel good, reduce further. If you continue to feel good after 2-3 weeks, try reducing this further to a quarter dose and see how you react.
If you need to increase the amount of probiotics once again do so. Otherwise, continue with this approach until you find the minimal maintenance dose that works here.
As you work to determine your minimal effective dose, keep an eye out for what’s known as the “nocebo” effect, or the expectation that you will need to continue probiotics (which can then lead to increased actual or perceived symptoms).
Finding your minimal effective dose will allow you to continue to reap the benefits of probiotics at a lower cost, with more convenience, and ideally with less of a feeling of dependency.
Keep in mind that probiotic use doesn’t have to be all or nothing, and maintaining a more relaxed attitude towards your supplementation can help to reduce dependency and anxiety. For example, taking probiotics some or most days rather than every day once you’ve reached your maintenance phase is completely fine.
Remembering What Probiotics Can Offer
While bacteria get a bad rap and are seen as something that can cause illness, not all are bad. We all have a variety of live bacteria in our guts, collectively known as the gut microbiome. Sometimes, though, the gut microbiome may get out of balance.
Probiotics are beneficial strains of bacteria that can help to benefit your system. In fact, the Food and Agricultural Organization of the United Nations defines probiotics as “Live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” .
We are the proverbial hosts. By increasing healthy bacteria, probiotics can assist us in a variety of different ways. Some of the potential benefits for health conditions include :
Aiding gut health by enhancing gut flora
Assisting the digestive system
Reducing constipation and easing bowel movements
Improving the immune system
Tamping down on intestinal issues
Improving skin health
Helping to improve stress-related disorders
With the potential for such benefits in mind, many are relying on their probiotic use these days. Just behind vitamins and minerals, probiotics are the third most popular category of dietary supplement that adults take .
Individuals give several reasons for taking probiotics. Those taking part in a 2019 study conducted at the Columbia University Irving Medical Center shared their thinking. Their most common reasons were :
Hoping to improve overall health and longevity
Hoping to improve gastrointestinal symptoms
Hoping that this would help with keeping a healthy weight
Hoping to improve non-gut related symptoms
Considering the Evidence
This is not just wishful optimism. Probiotics have been shown in a variety of studies to improve health and bring other benefits. For example:
When it comes to irritable bowel syndrome (IBS), probiotics have been found to tamp down on the gut inflammation, stop pathogen binding, and enhance the gut barrier function .
Probiotics have been shown to create a healthy immune response in the gut by improving gut flora .
Probiotics can reduce damage to the gut lining that may lead to leaky gut and turn this instead into a healthy gut [13, 14, 15].
Probiotics can benefit those with lactose intolerance without experiencing symptoms such as bloating, gas and pain. There is evidence that not only can these improve digestion but also the related uncomfortable symptoms .
Such research suggests that taking probiotics can offer all kinds of valuable health benefits. So, why would anybody want to stop taking these beneficial bacteria?
In my experience, many people who are reaping the benefits of probiotics may eventually start thinking about weaning themselves off. Some of their reasons may include concerns about:
Whatever your own thinking, whether it’s one of these reasons or something else, keep in mind that it’s all about best meeting your own individual needs.
Find What’s Right For You
Ultimately, when it comes to stopping probiotics, it all comes down to how you feel. You will likely be able to safely continue taking them without worry, but if you believe the time has come to reduce or eliminate your consumption of probiotics, the choice is yours. Weaning yourself off of probiotics is not an exact science and is something that you may want to continue to tweak as you go.
Now that you know how good you can feel, it’s all about finding the sweet spot that can keep you there in the long run.
To understand even more about what probiotics can offer and how to improve your gut health, read more in my book, Healthy Gut, Healthy You.
Some may also find it beneficial to consider a consultation at our functional medicine center for assistance in smoothly transitioning to your lowest effective dose of probiotics. This may help you find the best of the both worlds — enjoying the benefits of probiotics at a dose you feel good about taking in the long run.
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