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The Best Probiotic for BV: BV Treatment Over the Counter That Works

best probiotics for bv - bacterial vaginosis

Bacterial vaginosis (BV) can be an incredibly frustrating condition to live with. More often than not, it’s something that women deal with for months or years, with little help from their doctors. Luckily, using probiotics for BV can make treating this condition much easier! In this article, I’ll go over exactly what bacterial vaginosis is, the typical BV treatment, how to address recurring BV, and how probiotics for bacterial vaginosis can help.

In doing research for this post, I came across so many stories from women all over the Internet and it really broke my heart to read them. Women who experienced extreme pain during sex, said they were embarrassed to have any sexual contact, were constantly thinking about how “fishy” they smelled, or worried if they would ever find someone who could love them. There were many women who told their stories of living with BV for years, and could not find a solution.

So this article is dedicated to you — I hope it helps you find relief.

Disclosure: Some of the links in this post are affiliate links, which means that I receive compensation when you buy from these vendors. Please note that I vet each product and do not recommend products that I do not believe in. Thank you for supporting me!

What is BV (Bacterial Vaginosis)?

Bacterial vaginosis (BV) is an imbalance of good and bad bacteria (also referred to as dysbiosis) in the vagina. BV is thought to be a sexually-transmitted disease.

Normally, the majority of the bacteria in the vagina are from the Lactobacillus genus. When Lactobacilli are in high numbers, these bacteria keep the vaginal environment acidic by producing lactic acid, which helps to prevent “bad” bacteria from taking over.

BV is the most common cause of vaginal symptoms and it is believed that ~29% of women of childbearing age have bacterial vaginosis. The rates of BV differ between ethnicities, with Black women being at the highest risk (51%), followed by Mexican women (32%), and white women (23%). (1)

When you develop BV, there is a shift away from Lactobacillus bacteria toward a more diverse mix of bacteria. This imbalance of bacteria leads to an increase in the pH of the vagina, which can cause a number of symptoms.

Men cannot get bacterial vaginosis, though they may harbor some of the bacteria (Gardnerella vaginalis) that is thought to play a role in the development of BV in women. (2)

Bacterial Vaginosis (BV) Symptoms

Despite how common BV is, it does not always cause symptoms. In fact, 84% of women with BV do not exhibit any symptoms at all. (1)

That said, there are some tell-tale signs of BV. Symptoms of BV are often chronic and usually fairly mild. They include:

  • Thin, white or grey vaginal discharge
  • A strong fishy odor, especially after sex
  • Itching, burning, or pain in or around the vagina

Bacterial Vaginosis vs Yeast Infection

Despite the fact that yeast infections are talked about much more, they are the second most common cause of vaginal symptoms, beat out only by bacterial vaginosis.

So what’s the difference between the symptoms of bacterial vaginosis and a yeast infection?

Common symptoms of a yeast infection include itchiness or burning in or around the vagina, and a white discharge that often looks like cottage cheese. This discharge is typically odorless and might have a yeasty smell (like beer or bread). (3)

This differs from the thin consistency and strong fishy odor of the discharge associated with bacterial vaginosis.

Of course, the best thing to do if you have any of these symptoms is to visit your healthcare provider who can perform an exam and testing to determine which of these infections you might have.

Bacterial Vaginosis (BV) Causes

While researchers aren’t quite sure exactly what causes BV, there are certain lifestyle factors that may make you more likely to get BV.

Factors that may increase your risk of developing BV include (4):

  • Sexual activity. Having a new sexual partner or multiple sexual partners increases your risk of BV. Women who have not had sex rarely have BV.
  • Douching. Douching disrupts the balance of bacteria as well as the pH of the vagina, putting you at higher risk of BV.

Conventional BV Treatment

Some doctors do not recommend treatment of BV, especially if you have no symptoms. This is because the typical antibiotic treatment for BV can cause you to develop a yeast infection, essentially trading one infection for another. Many cases of BV also spontaneously resolve on their own.

However, treating BV makes you less likely to contract other STDs, including HIV. In addition, you are less likely to suffer from infections after gynecological surgery like an abortion or hysterectomy if you treat BV prior to surgery.

Lastly, if you are pregnant, having BV can increase the risk of having a preterm birth or a low birth-weight baby (<5.5 pounds at the time of birth). (4)

Most practitioners will choose to treat women who complain of symptoms of BV, women with BV who are about to undergo gynecological surgery, or pregnant women with BV, especially if you’ve had a preterm birth in the past.

Typical treatment for BV is a course of antibiotics. Antibiotics for BV include metronidazole (oral or vaginal), clindamycin (oral or vaginal), tinidazole (oral), or secnidazole (oral).

Recurring BV

Many women have recurring BV infections and find pharmaceutical antimicrobial treatment ineffective over the long-term. In addition to this, the side effects of antibiotics (such as yeast infections) can often make antibiotics seem not worth it.

If rings a bell, you might want to know how to stop recurring BV infections permanently or how to get rid of BV without antibiotics.

One thing to note here is that researchers believe that treating the sexual partners of those with BV may reduce recurrence rates. Early research in the field showed that this was not effective, but it was later discovered that this early research was not up to snuff. Researchers are now diving deeper into this topic and will hopefully have a definitive answer for us soon as to whether or not treatment of sexual partners can help reduce the recurrence of BV. (2)

In the meantime, there are numerous BV over-the-counter treatments as well as home remedies for BV that can make treatment a success and decrease the likelihood of a recurrent infection. One of my favorite options is probiotics!

Let’s jump into it.

Best Probiotic for BV

probiotics for bv - probiotic supplements

Because bacterial vaginosis is an imbalance of the good and bad bacteria in the vagina, taking probiotics orally or inserting probiotic bacteria vaginally can be useful in treating BV.

Taken orally, probiotic bacteria can actually help rebalance the vaginal flora. (5)

If you are interested in inserting probiotics vaginally for BV, make sure to discuss this option with your healthcare provider.

Below are some of the best probiotics for bacterial vaginosis.

Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 for BV

One of the most studied combinations of probiotic strains for BV is Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. (Remember that knowing the strain of the probiotics you’re taking is incredibly important — you can’t just take any probiotic!)

Study 1

In a study of 32 women with BV, half the women were given metronidazole and a combination of these two probiotic strains, while the other half were given metronidazole and a placebo. They received the antibiotics for the first 7 days of the study. As for the probiotics, they took two capsules (each capsule containing at least one million bacilli per strain) for the first 30 days, and then 1 capsule per day for the remaining 30 days of the study.

For those in the probiotic group, 81% (13 women) had cured their BV by day 30. They remained BV-free until the end of the study at 60 days, as well.

This is in contrast to the placebo group (remember, they still got the conventional treatment — 7 days of metronidazole). In this group, only 31% (5 women) were free of BV by the end of the study and almost 70% of the women who only received metronidazole treatment still had BV. (6)

Study 2

In another study (double-blind, placebo-controlled, randomized) on these two strains, women who had received these probiotics in addition to conventional metronidazole treatment for BV were cured at a much higher rate than those who only received metronidazole treatment.

125 women were split into two groups, and of those on the combination of probiotics and metronidazole, 88% were cured at the 30-day follow up. Only 40% of women who received metronidazole treatment alone were cured. (7)

Study 3

Another very similar study in 2017 showed, again, that women who took these probiotic strains in addition to metronidazole antibiotic treatment were much more likely to cure their BV. 83% of those who took the combination of probiotics and antibiotics for BV had cured their BV by the end of the 30-day study, while only 37% of women who only received antibiotics had cleared their BV by the end of the study. (8)

You may have also heard milk-based drinks with Lactobacillus cultures like Yakult for BV, or Actimel for BV. They do not contain the same strains of Lactobacillus as mentioned above, and thus may not be as effective for BV. That said, I’m always open to seeing more research so if you want to share any, please do so in the comments section!

Best Probiotic for BV that Includes Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14

Clearly, these two probiotics strains have some promising results for those with BV. If you’re looking for a BV treatment over the counter to help improve the efficacy of your medical treatment, probiotics are a wonderful choice. It’s an easy remedy that you can administer at home!

Fem-Dophilus from Jarrow Formulas is a great option if you’re looking for a probiotic supplement that contains these two strains.

You can also find these same strains in RepHresh Pro B probiotic capsules.

Ideally, I would love these companies to share the exact CFU counts for each individual strain, but none of them do (opting to list it as a “proprietary blend” instead). Both of these options contain 5 billion total CFUs, but they don’t specify how much of those 5 billion is coming from each of the strains. If you know of a brand that tells you how much of each strain their supplement contains, I’d love to hear about it in the comments!

Other BV Treatments Over the Counter & Home Remedies for BV

In addition to probiotics for BV, there are some other over the counter treatments for BV that you might want to consider.

Garlic for BV

In a study of 120 women with BV, 60 women were given 500 mg capsules of garlic and 60 women were given the standard treatment of metronidazole. 63% of women who received the garlic were successful in their treatment, while 48% were successful in the metronidazole group. (9)

This shows that garlic may be a better treatment for BV than antibiotics. Perhaps combined with the probiotics listed above, we’d see even higher rates of clearance!

If you’re looking for a quality garlic supplement, Allimax is a good choice.

Boric Acid Suppositories for BV

Boric acid suppositories have long been used for vaginal infections, including BV and yeast infections. It is regarded as a simple, safe home remedy for vaginal infections. It is thought that boric acid may affect the biofilms of BV-causing bacterial. (2)

One study showed that treatment with nitroimidazole followed by 21 days of intravaginal boric acid suppositories (600 mg) and then, if in remission, metronidazole gel twice weekly for 16 weeks. BV cure rates at 12, 16, 28, and 36 weeks were 87%, 78%, 65%, and 50%, respectively. (10)

Though the BV cure was not permanent for 50% of women in the trial, this study indicates that boric acid (along with other maintenance therapies), may be useful in delaying recurrence of BV. More studies are needed to determine if ongoing use of boric acid may be helpful for BV prevention, especially for those with recurring BV.

Please note: Oral use of boric acid is toxic — vaginal use only. Pregnant women should not use boric acid.

You can purchase boric acid suppositories online quite easily.

Other home remedies for BV that are less studied include: herbal suppositories (such as this one from Dr. Aviva Romm), tea tree oil for BV, and hydrogen peroxide for BV.

If you are considering any BV treatment over the counter or home remedies for BV, talk to your doctor.

The Bottom Line:

Bacterial vaginosis is the most common vaginal infection and affects almost 1 in 3 women. It causes symptoms such as thin, white or grey discharge with a strong fishy odor, and can cause itchiness or pain in or around the vagina.

Probiotics can be a great way to improve your chances of clearing BV. The best probiotic for BV are products that include both Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 strains. These can be found in both the Fem-Dophilus from Jarrow Formulas and RepHresh Pro B probiotic supplements. Taken orally, these probiotics can help rebalance the bacteria and lower the pH of the vagina and may help prevent and treat BV.

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Top 3 Best Prebiotic Supplements: Feeding Your Good Gut Bacteria

prebiotics

You hear a lot about probiotics these days, but what about prebiotics? What’s the difference between prebiotics and probiotics and should you be consuming both? In this article, we’ll cover everything you need to know about prebiotics and I’ll let you know about the top 3 best prebiotic supplements.

What Are Prebiotics?

Prebiotics were first defined in 1995 as “non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria already resident in the colon.” (1)

That definition has been tweaked throughout the years and the latest update to the definition (decided on by the International Scientific Association for Probiotics and Prebiotics (ISAPP)) is as follows: a prebiotic is “a substrate that is selectively utilized by host microorganisms conferring a health benefit.” (2)

But let’s put this in plain English, shall we?

A prebiotic “feeds” your healthy bacteria and, as a result, benefits you and your body. Prebiotics can be found in both foods (typically high-fiber foods) and supplements.

While “classic” prebiotics such as fructooligosaccharides and galactooligosaccharides still fit this new definition, this expanded criteria now also allows some non-carbohydrate nutrition components such as polyphenols (a type of antioxidant) to be classified as prebiotics.

Prebiotic vs Probiotic

What’s the difference between prebiotics and probiotics? Prebiotics and probiotics are quite different, despite very similar-sounding names!

While a prebiotic “feeds” good bacteria in your microbiome and offers you benefits in return, a probiotic is a live organism that beneficially impacts your body. (3)

You can think of a prebiotic supplement as the fuel for probiotics, which are the live bacteria that need feeding.

Probiotics can be found in food sources like yogurt, kefir, kvass, sauerkraut, and more. Prebiotic food sources include chicory root, garlic, onion, Jerusalem artichoke, and more.You can consume both probiotic supplements and prebiotic supplements. (We’ll talk about the best prebiotic supplements in just a moment.)

Both probiotics and prebiotics are exceptionally good for you, and I highly recommend incorporating both into your routine for best results. If you’d like to learn more about probiotics, check out my article on the topic here.

Can You Take Prebiotics and Probiotics Together?

Absolutely! In fact, it’s great to take prebiotics and probiotics together. However, when you’re looking at “synbiotic” supplements that contain both prebiotics and probiotics, be aware that most of these supplements only contain a very small amount of prebiotic. It is typically not enough to be considered a therapeutic dose of prebiotic and thus won’t have much of an effect on your health (but it can help the probiotic bacteria in your supplement survive better).

We’ll talk about the best prebiotic supplements in just a moment!

What’s the Difference Between Prebiotics and Fiber?

Many prebiotics are considered a type of fiber, so you will often see the term “prebiotic fiber supplement” used.

That said, not all types of fiber are considered prebiotics. The main difference between a prebiotic and fiber is what kind of bacteria they feed.

A prebiotic must selectively feed beneficial bacteria, whereas fiber is metabolized more broadly and thus can feed non-beneficial bacteria as well as good bacteria. (Note that this doesn’t mean that fiber isn’t good for you — it just acts somewhat differently from prebiotics.)

While prebiotics and fiber are very important parts of a healthy diet, remember that not all fiber is considered a prebiotic.

Prebiotic Benefits

Prebiotic supplements are a powerhouse when it comes to improving your health.

Here are some of the benefits of prebiotics you can expect.

Prebiotics & Digestive Health

Because prebiotic supplements selectively feed healthy bacteria, they can be used to help correct “dysbiosis” or imbalanced gut bacteria.

There are two main types of dysbiosis: general imbalance, and insufficiency dysbiosis.

General imbalance is when you have too few beneficial bacteria and overgrowths of one or more commensal bacterial strains. Commensal bacteria are bacteria that are normal to find in small amounts and typically don’t cause any harm to you. However, when they start growing in high amounts, you might start developing symptoms.

Insufficiency dysbiosis occurs when you don’t have enough beneficial bacteria like Lactobacillus or Bifidobacteria hanging out in the large intestine. These should be present in high amounts, but it’s very common to see folks with very little or no growth of these beneficial microbes. In the case of insufficiency dysbiosis, you do not need to have any bad bacteria species overgrowing.

Dysbiosis has been associated with a myriad of health conditions, like allergies, eczema, metabolic syndrome, obesity, inflammatory bowel disease, autoimmunity, and more. You can learn more about dysbiosis by reading my article on the topic here.

By consuming prebiotics, you can increase your counts of beneficial bacteria which improves the balance of your microbiome. A balanced microbiome means a healthy body!

Prebiotic supplements have been shown to improve lactose tolerance in those who are lactose intolerant, as well as improve symptoms of IBS like bloating, excessive gas, diarrhea, and constipation. (4, 5)

Prebiotic supplements can also improve IBS-like symptoms even more than a low-FODMAP diet alone when combined with this approach. (6)

Prebiotics, Weight Loss & Metabolic Function

Gut bacteria play a huge role in how your metabolic system functions. When gut bacteria in the microbiome become imbalanced (i.e. you have “dysbiosis), you can develop systemic low-grade inflammation, often referred to as “metabolic endotoxemia.” This is when toxic molecules such as lipopolysaccharides (LPS) get through a “leaky gut” into your bloodstream.

Researchers believe that this inflammation is at the root of many diseases, but it can especially impact the development of metabolic disorders such as obesity and diabetes. (7, 8)

Taking prebiotic supplements has been shown to improve fasting blood sugar, HbA1c, fasting insulin levels, and inflammation markers. (9)

Prebiotic intake has also been shown to increase satiety and decrease calorie intake, which may play a role in some of the positive metabolic changes seen with prebiotic consumption. (10)

Prebiotics & the Immune System

More than 70% of your immune system is housed in your digestive tract. (11)

This makes sense when you think about it — after all, your digestive tract is exposed to the many foods, particles, bacteria, etc that make it through your mouth on a daily basis. In order to keep you healthy, it must have a robust system in place to tolerate foreign particles that pose no pathological threat, while also being able to mount an attack toward pathogens that may negatively impact the body.

Prebiotic supplements have been shown to positively impact the immune system. Prebiotic consumption increases short chain fatty acid (SCFA) production, which in turn has been shown to promote T regulatory (Treg) cells, as well as other important immune cells. (12) Treg cells have a balancing effect on the immune system because they discourage autoimmunity (the attack of your own body’s cells).

Because of these effects, prebiotic supplements have been shown to improve atopic diseases such as asthma and eczema. (13, 14)

Prebiotics & The Brain

The gut and the brain are intimately connected — your brain “talks” to your gut and vice versa. At least on a subconscious level, we’ve known about this connection for a long time as evidenced by our use of phrases like “gut feeling,” “gutsy,” and “gut instinct,” but research is just starting to truly realize the extent of the connection between the brain and gut. (15)

Targeting the microbiome with microbiome-modulating things like prebiotic supplements and probiotic supplements is of great interest to researchers who study stress-related diseases such as anxiety, depression, and even conditions like irritable bowel syndrome.

Using prebiotic supplements has been shown to reduce waking cortisol response in adults. (16) In mice, prebiotic supplementation also shows antidepressant and anxiolytic effects. (17)

Because this is such a new field of study, I expect that we’ll see lots more about the effect prebiotic supplements can have on our mental health in the coming years!

Prebiotic Side Effects

There are very few side effects of consuming prebiotic supplements. That said, some people may experience slight increases in bloating when consuming large doses of prebiotics.

To avoid any digestive upset, it is best to start slow when increasing your intake of prebiotic supplements. Over time, your bacteria get used to having more and more fuel and you generally won’t experience digestive upset anymore.

Types of Prebiotics

There are many substances that act as prebiotics, and the list will surely become even longer in the coming years with the new, expanded definition of a prebiotic.

Some popular prebiotics include:

  • Inulin
  • FOS (Fructooligosaccharides)
  • GOS (Galactooligosaccharides)

With the expanded definition of prebiotics, there are some newer prebiotics available now as well, such as Sunfiber (also known as partially hydrolyzed guar gum or galactomannan fiber) and polyphenols.

Polyphenols are naturally-occurring compounds found in in plants. Some foods high in polyphenols include blueberries, coffee, strawberries, blackberries, flaxseed, tea, and wine. Recent research has shown that polyphenols act as prebiotics in the digestive system, increasing our counts of healthy gut bacteria. Learn more about polyphenols foods and their effect on gut bacteria.

Prebiotic Foods

Prebiotics can be found in both foods and supplements. Eating prebiotic foods can be a great way to get prebiotics in your diet if you’re not interested in taking prebiotic supplements.

Here is a list of foods that contain prebiotics (including polyphenol prebiotics):

  • Apples
  • Asparagus
  • Blackberries
  • Blueberries
  • Burdock root
  • Coffee
  • Chicory root
  • Chocolate (dark)
  • Dandelion greens
  • Flaxseed
  • Garlic
  • Jerusalem artichoke
  • Jicama
  • Leeks
  • Onions
  • Peach
  • Pear
  • Strawberries
  • Tea
  • Wine
  • Yacon root

Best Prebiotic Supplements

I’m a big fan of including prebiotics both from the diet and incorporating a prebiotic supplement.

Here are a few of the best prebiotic supplements on the market. Remember to start slow and ramp up your dosage over time to avoid digestive complaints, no matter what prebiotic supplement you take!

Bimuno (B-GOS)

Bimuno is the best prebiotic supplement that contains GOS (galactooligosaccharide). It’s generally very well tolerated, even by those with digestive issues. I typically recommend 1 stick of the powder formula (3.6g). Bimuno can be mixed into pretty much any beverage and is tasteless.

Sunfiber

Sunfiber is a new (and pretty unique) prebiotic fiber supplement. It is certified low-FODMAP by Monash University, so it’s the best prebiotic supplement choice for those who are FODMAP intolerant. It’s also been shown to improve clearance rates of SIBO (small intestinal bacterial overgrowth) when combined with the typical antibiotic treatment for this condition. (18) I generally recommend 6 grams of Sunfiber per day for best results. Sunfiber mixes in with hot or cold beverages easily and is tasteless and colorless.

FOS

NOW’s Nutraflora FOS is the best prebiotic supplement containing FOS (fructooligosaccharides). In general, I find FOS to be slightly less well-tolerated than the others on this list, but not by much! It’s got a nice sweet taste — I generally just dump it into my mouth and let it dissolve. I recommend 5 grams of FOS for best results.

What to Avoid in a Prebiotic Supplement

As prebiotic supplements become more popular, I’ve started to see lots of products claiming to contain prebiotics when they either don’t contain a substance that actually fits the definition of a prebiotic or they contain so little prebiotic that it is almost guaranteed not to actually benefit you when you take it.

Many supplements and foods claim to contain prebiotics when in reality they just contain fiber, so keep an eye out for that. Remember that fiber is absolutely great for you, but in my opinion it’s a bit of false advertising to claim that a fiber product contains prebiotics (unless, of course, that fiber is shown to be prebiotic).

You’ll also want to watch out for prebiotic supplements that contain extremely low doses of prebiotics. This typically happens in “synbiotic” products, which means that they include both a probiotic and a prebiotic. There is usually a tiny amount of prebiotic which does absolutely nothing for you as a human being, but can possibly increase the survival of the probiotic you’re taking. If you’re taking a prebiotic to benefit you, you’ll be taking grams of the stuff, not milligrams. Prebiotics are most often powdered supplements or quite a few capsules, since you need to take a lot for a therapeutic dose.

Lastly, prebiotics do seem to be somewhat like probiotics in that different types of prebiotics may be better suited for different uses. (Remember that the effects of probiotics are strain-specific.) Further research in the area will elucidate which prebiotic supplements are most beneficial for different conditions.

The Bottom Line

Prebiotic supplements feed the beneficial bacteria in your gut, which in turn make you healthier. You can consume prebiotics both in foods and prebiotic supplements — it’s a good idea to do both to ensure you’re properly fueling your microbiome.

Be wary of supplements that contain milligrams of prebiotics — while they may benefit probiotics contained in the supplement you’re taking, it’s not a therapeutic dose for you. If you want the benefits of consuming prebiotics, you generally need to take grams of the stuff!

The best prebiotic supplements on the market are Bimuno, Sunfiber, and Nutraflora FOS.

Top 100 High Polyphenol Foods: The Best Foods for a Healthy Microbiome

polyphenols foods

One of the best things you can do for better gut health is to eat a diverse diet full of high polyphenol foods.

If you’re a pretty healthy eater and consume lots of plant matter, you might be surprised to learn that you’re already eating quite a bit of high polyphenol foods. Even so, you can always strategically increase your polyphenol intake for even more health benefits.

In this article, we’ll discuss the high polyphenol diet: what it is, how to implement it, and the massive benefits you can expect once you implement this easy, delicious diet.

Let’s jump in!

What are Polyphenols?

Polyphenols, a type of antioxidant, are naturally-occurring compounds found in plants that benefit the human body in a myriad of ways. (1) Polyphenols include things like the flavanols in chocolate, anthocyanins elderberry and currants, stillbenes in wine, and lignans in flaxseed.

Polyphenols may improve microbial balance in the gut microbiome, regulate blood sugar, and improve your heart health, among other benefits.

You’ve probably heard the term “antioxidant” before, but perhaps not “polyphenol.” While polyphenols are an important sub-category of antioxidants, they haven’t received the attention that antioxidants have gotten in the last few years in the health sphere.

Newer research now shows that polyphenols do something quite incredible: they act as a prebiotic (a substance that fuels beneficial bacteria in your gut) for the microbiome. In return, your gut bacteria transform polyphenols into health-promoting metabolites that you’re then able to absorb into the body.

Polyphenols contribute the wide array of colors you see in your food: the red in the skin of your apple, the blue in your blueberries, and the green in your matcha. These beautiful colors indicate the presence of polyphenols in your food — therefore, the more color you can include in your diet, the more polyphenols you’ll get!

Eating foods high in polyphenols and a diet with a wide array of different polyphenols (i.e. different colors) helps the bacteria in your gut become more diverse. It is thought that microbial diversity in the gut microbiome is very important, as lower diversity is seen in health conditions such as IBD, metabolic syndrome, and allergic disease, among others. (2, 3, 4)

Polyphenol Benefits

So how exactly do polyphenols benefit your body?

Polyphenols make it through the entire digestive process mostly intact, making it down to the large intestine. Here, polyphenols serve as “food” for the healthy flora in your microbiome, while your bacteria “process” the polyphenols and transform them into beneficial metabolites that you can then absorb into the bloodstream. (5) Because of this, polyphenols classify as prebiotics.

Here’s what the research has to say about the benefits of polyphenols:

  • Increases counts of Akkermansia muciniphila, a beneficial species of bacteria. (6) Akkermansia spp. counts have been found to be low in people with health conditions like diabetes, metabolic syndrome, IBD, autism, and more. (7) This bacteria is crucial for the integrity of the gut barrier (i.e. is important in preventing “leaky gut”). (8)
  • May help to prevent age-related cognitive decline. (9) This particular study looked specifically at the impact of berry polyphenols. Berry polyphenols also seem to protect against neurodegenerative disorders, as well. (10)
  • May have anti-cancer effects. A number of polyphenols have been shown to have anti-cancer effects. (11) Tea polyphenols, in particular, can do a lot to help prevent UVB-induced skin cancer. (12)
  • May delay or prevent the development of metabolic syndrome. Intakes of polyphenols have been inversely associated with metabolic syndrome (meaning, the more polyphenols you consume, the less likely you are to have metabolic syndrome). (13) In addition to this, consuming polyphenols has been shown to delay or prevent the development of metabolic syndrome and improve markers such as body weight, blood pressure, blood sugar, and lipid metabolism. (14) It is thought that these beneficial effects may be due in part to the proliferation of Akkermansia spp. in relation to polyphenol intake.

Because polyphenols act as prebiotics, they help to prevent imbalanced gut bacteria or dysbiosis.

Foods High in Polyphenols

Given the benefits of polyphenols, you’ll want to incorporate as many high polyphenol foods as possible into your diet.

Luckily, researchers have analyzed many of the foods we have access to in order to determine which foods have the highest concentration of polyphenols per serving. (15)

Below are the top 100 high polyphenol foods, separated by category, and in order of polyphenols per serving within each category.

High Polyphenol Fruits:

Fruit:Serving Size (g):Polyphenol Content Per Serving (mg):
Black elderberry1451956
Black chokeberry1451595
Blackcurrant1451092
Highbush blueberry145806
Lowbush blueberry145395
Sweet cherry145394
Strawberry166390
Blackberry144374
Plum85320
Red raspberry144310
Pure apple juice248168
Apple110149
Pure pomegranate juice15099
Black grape5491
Pure grapefruit juice15079
Pure blood orange juice15471
Prune3262
Redcurrant14462
Peach9959
Green grape5448
Pure pummelo juice15427
Nectarine9925
Pear13823
Apricot6522
Quince10019
Bilberry1457.4
Pure lemon juice156.3
Banana972.5
Pomegranate1001.1

High Polyphenol Vegetables:

Vegetable:Serving Size (g):Polyphenol Content Per Serving (mg):
Globe artichoke heads168436
Black olive1585
Spinach5970
Green olive1552
Red onion3050
Potato12836
Shallot3236
Red chicory1433
Broccoli7233
Green chicory1423
Yellow onion3022
Asparagus6522
Extra virgin olive oil1610
Carrot547.6
Red lettuce245.4
Green bean604.8
Curly endive143.4
Cauliflower382.7
Rapeseed oil162.5
Pumpkin602.5
Endive (escarole)142.5
Tomato502.1
Green lettuce241.9
White onion301.6
Sweet green pepper200.9

Nuts, Seeds, Grains, and Legumes High in Polyphenols:

Food:Serving Size (g):Polyphenol Content Per Serving (mg):
Flaxseed meal20306
Chestnut19230
Whole grain rye bread120146
Hazelnut28138
Soy yogurt125105
Soy flour2093
Pecan nut1569
Soy, tempeh4059
Soy tofu13054
Black bean3552
White bean3544
Roasted soybean1537
Soy meat4029
Whole grain rye flour2029
Almond1019
Whole grain wheat flour2014
Soybean sprout609.3
Soy cheese404.9
Peanuts, roasted dehulled402.6
Pasta602.5
Refined oat flour201.6
Refined wheat flour201.2

Other Foods High in Polyphenols:

Food:Serving Size (g):Polyphenol Content Per Serving (mg):
Coffee, filtered190408
Dark chocolate17283
Black tea195197
Green tea195173
Red wine125126
Cocoa powder3103
Milk chocolate3275
Chocolate beverage with milk18739
Soy milk18734
Beer57422
White wine12513
Rose wine12512
Dark beer57410

How to Eat a High Polyphenol Diet

For the most diverse, healthy microbiome, your diet should be as high in polyphenols as possible.

Here’s how to easily eat a high polyphenol diet.

Eat More High Polyphenol Foods

One of the easiest ways to get more polyphenols in your diet, of course, is to incorporate more of the high polyphenol foods on the lists above into your eating habits.

For example, if you normally eat two eggs and a smoothie for breakfast, you could choose particularly high polyphenol fruits and vegetables to add to your smoothie (and maybe even some flaxseed meal, too!) and spice up your eggs with some herbs. Drink a cup of tea or coffee on top of that and you’ve got a nice high polyphenol meal!

Instead of having some ice cream for dessert after dinner, you could instead choose a few pieces of dark chocolate to amp up your polyphenol intake.

Wherever you can, choose high polyphenol foods to incorporate into your diet and you’re bound to eat more polyphenols than you were before.

Eat at Least 40 Different Plant Foods Each Week

Gut researcher and educator Jason Hawrelak of ProbioticAdvisor.com recommends trying to eat at least 40 different plant foods each week, and I tend to agree with this advice.

When doing this, note that a purple carrot counts as a different food than an orange carrot when counting your plant foods each week. Your different herbs and spices count separately, too!

So instead of eating white potatoes each night for dinner, you’re better off eating white potatoes some nights, but also incorporating sweet potatoes, japanese potatoes, purple potatoes, etc to help you more easily reach your 40 different plant foods each week.

The easy rule of thumb to remember is: the more diverse the colors (polyphenols) in your food, the more diverse your microbiome!

Change Up Your 40 Plant Foods Each Week for Maximum Diversity

If you want to go above and beyond and really maximize your microbial diversity, you can change up your 40 plant foods each week as much as possible.

While it would be great to have an entirely different set of 40 plant foods each week, for most people that will be quite difficult. Instead, just try to change as many foods as you can from week to week!

By doing this, you help to encourage microbial diversity in your gut. This is because each different polyphenol helps to encourage the growth of different beneficial bacteria in the gut.

The Bottom Line

Polyphenols give the wide array of colors we see in our food and act as prebiotics in the gut to feed your beneficial bacteria. The more high polyphenol foods you can incorporate into your diet, the more diverse your microbiome becomes. Microbial diversity in the gut is associated with better health outcomes.

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The Role of Gut Bacteria in Fertility and Estrogen Dominance

high estrogen levels fertility

I’ve talked before about the importance of optimizing your gut health before getting pregnant in order to promote a healthy pregnancy for both you and your baby.

But what about getting pregnant in the first place… Can your gut bacteria play a role in your estrogen production and fertility?

The science suggests that it very well might!

To understand why let’s take a closer look at infertility and one of its common causes: estrogen dominance.

What is Infertility?

When you hear the term “infertility,” you likely think of a person or a couple that cannot and will never be able to have children. In the medical world, however, infertility does not refer to a permanent state at all.

A diagnosis of infertility simply means that you have not been able to get pregnant after a year of normal, unprotected sex (1).

It’s actually a diagnosis that is far more common than you might realize. According to recent statistics, between 7% and 15.5% of American women experience infertility in any given year, and the majority of women (51.8%) meet the criteria for infertility at least once during their menstruating years (2).

Infertility & Estrogen Dominance

While there are many reasons a couple might have difficulty getting pregnant, among the most common are hormone imbalances (3, 4).

Abnormally high levels of estrogen is frequently implicated in infertility in both men and women. (5, 6, 7, 8).

Let’s look at the connection between high estrogen in both men and women and how it affects fertility.

High Estrogen in Women & Infertility

Most women need little reminder that our fertility depends on a highly-coordinated 28ish-day cycle in our hormone levels. Most of us also know that one of the key players in this hormonal dance is estrogen.

Estrogen has two very important jobs in the female menstrual cycle. First, it triggers a spike in the levels of a hormone called luteinizing hormone (LH) from the pituitary gland in the brain. This spike in LH levels is what triggers the ovary to release a mature egg into the fallopian tube, where it can be fertilized (9).

After a successful ovulation, though, estrogen works together with yet another hormone called progesterone to prevent a second ovulation from occurring. Estrogen and progesterone do this by acting on the pituitary gland in the brain to make sure no more LH is made until the following cycle (or, if pregnancy occurred, until after birth). At the beginning of the next cycle (menstruation), estrogen and progesterone levels dip down, signaling to the brain that it is safe to produce another spike of LH (9).  

Constant high levels of estrogen, without a significant dip signaling the start of a new cycle, can trick your brain into thinking you’ve already ovulated, and prevent you from ovulating again (9). This is actually the logic behind hormonal birth control (the pill).

As you might imagine, this high level of estrogen can play a significant role in infertility.

High Estrogen in Men & Infertility

While we often think of estrogen as a female hormone, men also have healthy baseline levels of estrogen that are required for sexual and reproductive functions.

At moderate levels, estrogen promotes (and is necessary for) a healthy libido and the production of sperm in men. High estrogen, however, can have the opposite effect (6).

Too much estrogen in men decreases their libido. This is because, as in women, estrogen in men acts on the pituitary gland in the brain to decrease the production of LH. In men, this hormone stimulates the testes to produce testosterone. Without enough LH, there is a drop in testosterone, and low testosterone lowers male libido (6).

Too much estrogen in men can also decrease the production of sperm by the testes. This is due to the estrogen-induced decrease in LH and testosterone levels, both of which directly stimulate the testes to produce mature sperm (6).

Estrogen Dominance Symptoms

So how do you know if you’re at risk of having too much estrogen? Here are some symptoms of high estrogen levels to look out for.

High Estrogen Symptoms in Women:

  • Irregular periods
  • Breast tenderness or soreness
  • Decreased sex drive
  • Bloating
  • Increased mood swings
  • Increased symptoms of PMS (premenstrual syndrome)
  • Headaches
  • Anxiety
  • Weight gain
  • Fatigue
  • Memory issues

High Estrogen Symptoms in Men:

  • Infertility
  • Sexual dysfunction (erectile dysfunction, low libido)
  • Enlarged breasts (gynecomastia)
  • Fatigue

If you’re worried you might have high estrogen levels, the best thing to do is to have your hormones tested by your healthcare practitioner. But knowing the symptoms of high estrogen may help you determine if a visit to the doctor might be helpful.

Estrogen & Gut Bacteria

Clearly, a buildup of estrogen is not optimal for you, or your partner’s, fertility. But what’s any of this have to do with your gut bacteria?

A lot, believe it or not! There are multiple mechanisms which link your gut bacteria to your estrogen levels. This concept is often referred to as the “estrobolome,” which is defined as the bacterial genes in your microbiome that have the ability to metabolize estrogen.

Gut Bacteria and Estrogen Reabsorption

Your gut bacteria are actually an integral part of the normal regulation mechanisms your body uses to keep estrogen levels normal.   

See, every day your liver pulls estrogen out of your blood and binds it to a sugar-metabolite called glucuronic acid. This sugar-estrogen complex is then mixed with your bile, which is dumped into your digestive tract to help with digestion (10, 11, 12).

Now, this sugar-estrogen complex is bigger than estrogen by itself and it can’t be absorbed through the intestinal wall very well. Because of this, much of the estrogen gets stuck in the intestines and is eliminated from your body via bowel movements (10, 11, 12).

And this is where your gut bacteria come in. They have special enzymes that are able to cut estrogen free from the sugar, called β-glucuronidases. The freed estrogen molecule can then be easily absorbed and re-enter your bloodstream (10, 11, 12).

This is a natural part of the process and the liver binds more estrogen to bile acids than needed with the knowledge that some of it will be coming back, thanks to your gut bacteria.

This balance can be upset, however, if you have abnormal numbers, types, or ratios of bacteria in your intestines (called dysbiosis) (13).

This is because some gut bacteria have β-glucuronidases that free estrogen better than others (14). With an unhealthy mix of gut bacteria, your microbiota can free too much estrogen, allowing much greater levels of estrogen to be reabsorbed back into your body than normal, which results in excess estrogen in the blood (13).

Gut Bacteria and Estrogen from Food

In addition to the role the gut microbiota play in balancing the levels of estrogen you make yourself (called endogenous estrogen), they also regulate how much estrogen and estrogen metabolites you absorb from food sources (called exogenous estrogen).

Some gut microbes have enzymes that enable them to breakdown phytoestrogens (from plants) and polycyclic aromatic hydrocarbons (from barbequed or fried meats) into estrogens (15, 16). These estrogens can then be absorbed through the intestinal wall, raising your blood levels.

In fact, studies show that in men and postmenopausal women, the number one source of estrogen for their whole bodies is intestinal absorption from their food (17). And dysbiosis is associated with higher levels of estrogen in these populations, presumably at least partially through increasing the breakdown of dietary molecules such as phytoestrogens and polycyclic aromatic hydrocarbons (13).

Indirect Ways Gut Bacteria Affect Estrogen Levels

In addition to the direct ways dysbiosis links your gut health to higher estrogen levels, there are also several indirect links.

For example, an abnormal balance of gut bacteria has been strongly linked to constipation (18, 19), inflammation (20) and obesity (21), all of which may be able to further drive up estrogen levels in your blood (8, 22, 23).

How to Lower Estrogen Levels

If you have high estrogen levels and you’re looking to get your estrogen into the normal range, there’s a lot you can do from a dietary and lifestyle standpoint.

If you hope to get pregnant and your estrogen levels are too high, incorporating these diet and lifestyle changes may help improve your fertility.

Eat More Fiber for Lower Estrogen Levels

Research shows that one of the most beneficial things you can do to optimize your estrogen levels is increase your fiber intake.

A high fiber diet is associated with improved microbial health and decreased risk of dysbiosis (24). In fact, increasing the amount of fiber in your diet for just 2 weeks is enough to significantly improve the composition of your gut bacteria (25).  

Additionally, fiber may be able to directly bind the estrogen-sugar complex in the digestive tract, helping eliminate it from the body. In a study examining estrogen (re)absorption in women, there was a direct and significant relationship between a woman’s fiber intake, the size of her stool, and the amount of estrogen she was able to flush from her body (26).

How you choose to increase your fiber intake is up to you, but boosting your fiber intake by increasing the amount of fiber-rich foods in your diet, rather than through adding fiber supplements, may give you more bang for your buck.

This is because the dietary source of fiber — plants — are also rich in polyphenols (27, 28, 29). As I outline here, polyphenols can help boost the health of your gut bacteria, so plant-based fiber-rich foods treat dysbiosis to a one-two punch.

Supplement with Fiber

That said, for many people, incorporating a fiber supplement may be the easiest solution (in addition to a plant-rich diet, of course!). The best fiber supplement on the market (in my opinion) is Sunfiber.

Diet and Lifestyle Changes to Lower Estrogen

While fiber (and fiber-polyphenol-rich plants) is the most well established dietary tool to prevent dysbiosis and lower blood estrogen levels, other dietary and lifestyle changes may also be helpful. These include:

  • Exercising regularly (30)
  • Drinking enough water to stay properly hydrated, preventing constipation (31)
  • Taking a probiotic, which contains healthy gut bacteria that can help populate your gut with healthy microbes (32) (Want to know more about supplementing with probiotics? Check out my article on the topic here.)
  • Avoiding broiled, fried and barbecued meats that are likely to contain high levels of polycyclic hydrocarbons, which can contribute to high estrogen levels, especially if you have dysbiosis (33)

Healing Your Gut to Lower Estrogen

If you have a lot of digestive symptoms like constipation, diarrhea, bloating, or gas, you may need help beyond these simple dietary and lifestyle changes listed above.

This is because digestive symptoms can indicate that you have severe dysbiosis, or conditions like SIBO or parasites that need a more in-depth approach, including antimicrobials (or antibiotics) and other supplements.

That said, you can have imbalanced gut bacteria without any symptoms at all, so if you want to maximize your chances of getting pregnant or prevent estrogen dominance, it’s a good idea to test even if you don’t have digestive symptoms.

There are multiple tests to determine the health of your gut microbiota that can give you more precise information regarding your gut health. This can provide you with a roadmap to optimizing your digestive health and, in turn, your fertility.

If testing indicates you have dysbiosis, SIBO, or any other type of imbalanced gut flora, you’ll want to clear out that bad bacteria and balance your biome. If you need more help with that, check out my 8-week online program, Build Your Biome.

For women who have ever struggled with infertility, did you experience that taking care of your gut health through diet and lifestyle changes made a difference in your ability to get pregnant?

For women who are thinking about starting a family in the near future, do you think you will consider your gut health more now, before you start trying? Tell me in the comments below!

What Probiotics to Take While You’re On Antibiotics

What Probiotics to Take While You're On Antibiotics

In this article, you’ll learn how probiotics can prevent some of the negative side effects of antibiotics and keep your gut healthy. You’ll discover the best probiotic supplements on the market for antibiotic-associated diarrhea and other digestive problems, as well as what probiotic foods to eat. 

What are Antibiotics?

What are Antibiotics Used For?

Antibiotics are a class of drugs that kill bacteria. They are used for harmful infections in or on the body. Common antibiotics include clindamycin and amoxicillin, though there are many different types of antibiotics on the market.

How Do Antibiotics Work?

Antibiotics work by either directly killing bacteria or preventing them from replicating or reproducing, thus dwindling bacteria numbers over time.

Antibiotic drugs only kill off bacterial infections in the body, which means that they aren’t useful for illnesses like the common cold or the flu, for example, because these are viral illnesses.

Side Effects of Antibiotics

Unfortunately, antibiotics are associated with a few side effects. These include:

  • Digestive problems
  • Clostridium difficile infection
  • Altering the Microbiome
  • Antibiotic Resistance

Digestive Problems

The most common side effects of antibiotics are digestive problems. These include:

  • Nausea or vomiting
  • Abdominal pain or cramping
  • Diarrhea (commonly referred to as antibiotic-associated diarrhea)

Luckily, many of the digestive problems that are caused by antibiotics can be helped by probiotic supplementation. We’ll go over that in just a minute, but hold tight — there are a few other common side effects of antibiotics that we’ll cover first.

Clostridium Difficile Infection (C.diff)

Clostridium difficile is an infection that causes diarrhea and inflammation of the colon. It is associated with recent antibiotic use and being in a healthcare setting.

Researchers have found that during antibiotic use as well as one month after the fact, your risk of developing c.diff increases 7-to-10 fold. One month after antibiotic treatment, your risk of developing c.diff increases threefold until three months after treatment. (1)

Common antibiotics that are associated with c.diff infection include clindamycin and fluoroquinolones (such as ciprofloxacin (Cipro), gemifloxacin (Factive), and levofloxacin (Levaquin), among others).

Altering the Microbiome

While it’s easy to see how antibiotics can cause digestive upset or even serious infections like c.diff, you may not realize that taking antibiotics actually causes negative shifts in your microbiome (the bacteria in your gut). Your microbiome responsible for a number of tasks in keeping you healthy, including aiding in digestion, nutrient production, immune response and more.

This negative bacterial shift leads to a condition called “dysbiosis” — essentially, an imbalance in the proper amounts of good and bad bacteria in your gut. Dysbiosis can lead to digestive problems like bloating, excessive gas, reflux, constipation, and diarrhea, but it is also associated with a host of chronic diseases as well. If you’d like to know more about dysbiosis and the chronic diseases it is associated with, make sure to check out my article on the topic here.

Clindamycin, one of the antibiotics I mentioned above, has been shown to cause unfavorable changes in healthy gut flora even two years after treatment. (2) Clindamycin also has a lot of unpleasant side effects including gastritis, gas and bloating, diarrhea and can lead to C.diff infections, as I mentioned before. (3) For more examples of how specific antibiotics affect the gut microbiota and their related side-effects, check out this research article. Clindamycin is by far one of the worst antibiotics in terms of unfavorable bacterial changes, but it’s wise to take a look at the research on the effects of any antibiotic you’re thinking of taking.

While we know there are risks to taking antibiotics, the reality is sometimes we need them. The point of this article is not to discuss antibiotic alternatives like natural antibiotics (though that’s certainly an important discussion); rather, it is to give you advice on what probiotics are useful in reducing the side effects of antibiotics.

Antibiotic Resistance

Antibiotic resistance happens when bacteria are able to resist the effects of an antibiotic. Not good! When we take an antibiotic we want it to work, right? When bacteria start to become resistant it means that things that were once easily curable with antibiotics may no longer be killed off by these same drugs.

When antibiotics are overprescribed and overused, this can (over time) cause antibiotic resistance. There will always be a few bacteria that are resistant to an antibiotic that you take. After you’ve finished your course, any bacteria that remains are those that are resistant to the drug. They are now allowed to grow freely and you’re no longer protected by your microbiome’s good bacteria. The more you take antibiotics, the stronger those resistant bacteria get.

Now this isn’t to say that you shouldn’t take antibiotics when they are prescribed to you. Antibiotics are life-saving drugs, after all. But it means that you should have a frank conversation with your healthcare provider about whether antibiotics are necessary (some doctors are still prescribing antibiotics (often because the patient asks for them) for illnesses like the common cold, which is not affected by antibiotics since it’s a virus).

heal your gut

What are Probiotics

probiotics

Probiotics are live microorganisms that have a beneficial effect on the host (that’s you!). Your microbiome contains tons of probiotics and you can also consume probiotics exogenously through the use of probiotic supplements or probiotic-rich foods.

What Do Probiotics Do?

Probiotics have a whole range of benefits. They improve the side effects of antibiotics (like diarrhea), which we’ll discuss shortly. But in addition to this, probiotics have been shown to be useful for a wide array of health conditions.

Probiotics can help with the following conditions (among others):

  • Irritable bowel syndrome (IBS) (4)
  • Depression (5)
  • Anxiety (6)
  • Cardiovascular disease (heart disease) (7)
  • Metabolic disease and diabetes (8)

Side Effects of Probiotics

The common side effect of probiotics is increased digestive discomfort, such as bloating or gas. This is typically short-lived and resolves in a few days of regularly consuming probiotic supplements or probiotic foods.

More serious side effects are possible, but extremely rare. The bacteria or yeast that is consumed as a probiotic supplement can enter the bloodstream and cause infection. Those who are at increased risk of infection include immunocompromised patients, premature infants, those with short bowel syndrome, anyone with central venous catheters, and patients with cardiac valve disease.

It is, of course, important to discuss any supplementation with your healthcare provider.

Best Probiotics

There are many probiotic supplements on the market, so how do you know which one to choose?

Well, the right probiotic to choose depends on what you’d like it to do. Probiotic effects are strain-specific, meaning that different strains have different effects on the body. If you want to reduce anxiety you could take a strain called Bifidobacterium longum R0175, while this strain may not be as effective if you wanted to prevent c.diff infection.

So as you can see, it’s important to choose the right probiotic strain for the job!

Best Probiotic Supplements While on Antibiotics

There are a lot of myths floating out there about whether or not to take probiotics during an antibiotic course. The argument goes a little something like this: “I’m taking an antibiotic that kills bacteria – why would I take a probiotic? Wouldn’t my antibiotic just kill the probiotic?”

The answer is that probiotic supplements during antibiotic treatment has been shown to reduce the severity of antibiotic-associated diarrhea. (4) So even though your antibiotics might kill off some of those good gut bacteria, probiotics still reduce the negative side effects of antibiotics.

Here’s a list of the most researched and effective probiotic supplements for reducing the incidence and severity of antibiotic-associated diarrhea. These are some of the best probiotic supplements on the market.

  • Saccharomyces boulardii biocodex (now called Saccharomyces boulardii CNCM I-745) is found in the Florastor brand probiotic and helps to prevent C.diff infections (5) and even helps those who tend to have recurrent C.diff infections. (6). This strain does not need to be refrigerated, so it’s very easy to buy saccharomyces boulardii online.
  • Visbiome (a multi-strain probiotic) has also been shown to reduce the incidence of antibiotic-associated diarrhea.(7) Note that if you buy Visbiome online, you should choose a retailer that ships it refrigerated. (Please note: I used to recommend VSL #3 as it was the brand that use the De Simone probiotic formula. However, they have since lost access to the well-researched formula, and now Visbiome has the only rights to it. Make sure you get Visbiome and NOT VSL #3 if you’re looking for the De Simone formula.)
  • Lactobacillus rhamnosus GG (found in the Culturelle supplement) has been shown to reduce the occurrence of antibiotic-associated diarrhea, as well.(8) Like Florastor, it’s easy to buy Culturelle online since it does not need to be refrigerated.

Antibiotics also tend to cause an overgrowth in yeast (particularly candida albicans). In a study on patients provided probiotic supplementation with Lactobacillus acidophilus CUL60 and CUL21 and two species of Bifidobacterium spp., those who supplemented probiotics along with antibiotics showed less of an increase in yeasts compared to the placebo group. (9) S.boulardii, mentioned above, has been shown to help prevent some of the virulence factors related to C. albicans. (10) I have not seen any research to date on the effects of VSL #3 or Lactobacillus GG on C.albicans or other yeasts, but please chime in in the comments section if you are aware of any.

From the research, I think any of these probiotics are a good choice while taking antibiotics, but it is likely that S. boulardii has a slight advantage in that helps to deal with the overgrowth of yeast that is common with antibiotic treatment. However, research has shown that other probiotic strains can be helpful in this regard as well, so it is likely that VSL#3 and Lactobacillus can be useful in keeping yeast counts down also.

It’s not necessary to take all of these probiotics (it would be pretty expensive!), though I doubt it would hurt you in any way.

If you can’t find any of these probiotics, I still think you’re better off taking any probiotic that is available to you. Though there may not have been research on the particular strains contained in your supplement (and probiotic effects are strain-specific), it is likely that probiotics in general are helpful in preventing some of the unfortunate side effects of antibiotic treatment.

Probiotic Foods

Eating probiotic-rich foods can also be useful in preventing the negative side effects of antibiotics.

High probiotic foods include:

  • Kombucha
  • Yogurt
  • Kimchi
  • Sauerkraut (make sure to buy the kind in the refrigerated section, not off the shelf)
  • Kefir
  • Pickles (again, this should be in the refrigerated section if it has live cultures; if not, they are vinegar-based pickles and will not contain probiotics)
  • Kvass

In addition to buying probiotic foods at the grocery store, you can also make your own! They are very simple to make, and you can even buy starter cultures online to make the process easier. Check out Thrive Market who sells some of these starter cultures (in addition to tons of really healthy foods delivered straight to your door).

I recommend taking both a probiotic supplement and consuming probiotic foods while you’re on antibiotics.

Wrapping it All Up

As you can see, probiotics are a powerhouse when it comes to preventing the negative side effects of antibiotics.

If you’re looking for the best probiotic supplement to take to prevent these symptoms, choose one of the following in addition to consuming fermented foods:

Ready to learn more about healing your gut? Watch my FREE training by clicking the image below!

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How to Heal Your Gut After Antibiotics

Once you’ve finished your antibiotic course, you’ve got some damage control to do. Antibiotics certainly take a toll on the gut, so it’s important to continue babying your gut after you’re done.

Read my next article, How to Heal Your Gut After Antibiotics to learn how to do just that!

How To Heal Your Gut After Antibiotics

How To Heal Your Gut After Antibiotics

Now that you’ve learned what probiotics to take while you’re antibiotics, you’re probably concerned with what you should do after you’ve finished your course.

Antibiotics take a toll on our microbiome, destroying lots of our good bacteria and causing overgrowth of others like yeasts. This imbalance of gut bacteria is called dysbiosis. So how do we fix it?

Probiotics After Antibiotics

There is some recent research suggesting that probiotic consumption after antibiotic treatment may delay your microbiome from returning to its normal state, so if you’re not experiencing any digestive complaints after finishing your course of antibiotics, I recommend focusing mostly on prebiotics (see below) as opposed to probiotics.

If, however, you’re struggling with some post-antibiotic digestive woes, you may want to try a probiotic in addition to the other suggestions in this article. If you already began taking probiotics during your course of antibiotics, you can continue that probiotic for a month or two after finishing up your course.

Take a Probiotic Supplement

If you weren’t taking a probiotic during your antibiotic course, you can choose one of the below (which I recommended in my previous article):

  • Saccharomyces boulardii biocodex (now called Saccharomyces boulardii CNCM I-745) is found in the Florastor brand probiotic and helps to prevent C.diff infections (5) and even helps those who tend to have recurrent C.diff infections. (6). This strain does not need to be refrigerated, so it’s very easy to buy saccharomyces boulardii online.
  • Visbiome (a multi-strain probiotic) has also been shown to reduce the incidence of antibiotic-associated diarrhea.(7) Note that if you buy Visbiome online, you should choose a retailer that ships it refrigerated. (Please note: I used to recommend VSL #3 as it was the brand that use the De Simone probiotic formula. However, they have since lost access to the well-researched formula, and now Visbiome has the only rights to it. Make sure you get Visbiome and NOT VSL #3 if you’re looking for the De Simone formula.)
  • Lactobacillus rhamnosus GG (found in the Culturelle supplement) has been shown to reduce the occurrence of antibiotic-associated diarrhea, as well.(8) Like Florastor, it’s easy to buy Culturelle online since it does not need to be refrigerated.

Eat Probiotic Foods

You’ll also want to focus on including plenty of probiotic-containing foods for the next few months (you should always include these in your diet, but it’s especially great to do so right after taking antibiotics). Here’s a list of fermented foods, including (but not limited to) the following:

  • Water or Dairy kefir – fermented water (often with juices or fruit included for flavoring in a “second ferment”) or dairy with kefir “grains”. Click here for a recipes, or purchase at your local natural foods store
  • Kombucha – a fermented tea drink. Click here for a recipes, or purchase at your local natural foods store
  • Kimchi – a spicy fermented cabbage, a Korean staple (and my personal favorite!). Click here for a recipe and try it at a Korean restaurant for a taste. You can often purchase this in tubs at Korean grocery stores as well.
  • Sauerkraut – another fermented cabbage, but a German version this time! Click here for a recipe or you can pick up some Bubbie’s sauerkraut at Whole Foods or other natural foods store
  • Pickles – the deli classic can be made by fermenting cucumbers! Click here for a recipe and keep in mind these are different from the pickles in vinegar you’d find on the shelf of your regular grocery store.
  • Salsa – another classic dish that can take a fermented turn! Click here for a recipe and give it a shot!
  • Beet kvass – a fermented beet juice drink. Click here for a recipe or you can usually find this in your Whole Foods or other natural foods store.
  • Yogurt – if you tolerate dairy, yogurt is a great source of probiotics. Click here for a recipe or of course you can pick some up from your grocery store (choose one that uses a good quality milk though and always buy full fat!)

Keep in mind that you can ferment pretty much anything! My favorite resource for fermentable foods is the book Wild Fermentation by Sandor Katz and you may also want to check out Fermented by Jill Ciciarelli. This is one of the most fun ways to experiment in the kitchen, so get fermenting!

Prebiotics After Antibiotics

Prebiotics are a wonderful thing to incorporate into your diet and supplement routine after antibiotics. A prebiotic is a “nondigestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improves host health.” (1) This definition was later revised to include that a prebiotic:

“a) resists gastric acidity, hydrolysis by mammalian enzymes and gastrointestinal absorption;

b)  is fermented by the intestinal microflora;

c) stimulates selectively the growth and/or activity of intestinal bacteria associated with health and wellbeing.” (2)

Supplementing with Prebiotics after Antibiotics

Prebiotics work by selectively feeding your beneficial gut bacteria, which in turn, helps to push out unwanted or “bad” bacteria that might be hanging out in the gut.

You can think of the microbiome as a parking lot — there’s only so many spaces available. Taking prebiotics helps your good bacteria to take more of those parking spots and leaves less spots available for any bad bacteria.

Best Prebiotics:

1) Fructo-oligosaccharides: FOS is found is a variety of foods including Jerusalem artichokes, chicory root, onions, bananas, honey, garlic and leeks. (3) The appropriate dose of FOS is about 10 grams per day (this leads to increases in bifidobacteria and has the least amount of side effects (which tend to be gas and bloating)). (4) Whether you get this dose from food or supplement is up to you, but it will help to correct the dysbiosis caused by antibiotic treatment. My favorite FOS supplement is NOW Foods UltraFlora FOS powder. (P.S. it tastes like cotton candy.)

2) Galacto-oligosaccharides: GOS isn’t found in many foods, so if you’d like to try this one you’ll need to supplement. A dose of 5 grams per day has been shown to be bifidogenic (increases bifidobacteria counts) in most healthy people while consuming it along with their usual diet. (5) Try Klaire Labs Galactomune supplement.

3) Sunfiber (galactomannan fiber or partially hydrolyzed guar gum): Sunfiber is a great choice as it is low-FODMAP and thus typically very well tolerated even by those who are experiencing digestive issues. I recommend 6 grams per day, which has been shown to be a bifidogenic dose.

When starting on prebiotic supplements, it’s important to begin with a small dose and work your way up slowly. It’s normal to experience a bit of extra gas or bloating when increasing your dose, but it should dissipate within a couple days.

Incorporate High Polyphenol Foods Into Your Diet

Polyphenols, a type of antioxidant that gives our food color, actually act as prebiotics in the gut. This means that the more high polyphenol foods you incorporate into your diet (like berries, tea, spices, etc), the better balanced your microbiome will be.

Because each different polyphenol feeds different classes of healthy bacteria, it’s best to incorporate a wide array of colorful fruits and veggies into your diet.

What if Probiotics and Prebiotics Aren’t Enough?

Because of the intense effect antibiotics can have on our gut flora, sometimes simply adding probiotics and prebiotics doesn’t quite cut it.

Maybe you’ve noticed that your digestion is just off after taking a course (or a few courses) of antibiotics. What do you do then?

Well, a good first step is to have your gut bacterial balance tested.

There are two common imbalances that can result from antibiotic treatment. The first, which we just discussed, is called dysbiosis.

The second is something called SIBO (small intestinal bacterial overgrowth).

Both of these conditions can cause many annoying digestive symptoms and can be difficult to deal with.

You can learn more about both of these conditions and the testing you need to identify them in this blog post.

If you’re experiencing lots of digestive symptoms like bloating, gas, diarrhea or constipation long after being on antibiotics, it’s definitely time to test for SIBO and dysbiosis. (Note: you’ll need to wait at least 2 weeks after being on antibiotics to do these kinds of tests.)

Once you identify these imbalances, you can get to work clearing out bad bacteria and healing your gut. This typically involves an antimicrobial protocol (or antibiotics — but don’t worry, these ones aren’t like the ones that got you here in the first place!), gut-healing supplements, stress management, and a proper diet.

I have an entire 8-week course dedicated to this process called Build Your Biome. If you’re totally overwhelmed by all the research you need to do to kick these symptoms to the curb, I invite you to join me in BYB where I make it all super easy!

Takeaway: By getting probiotics and prebiotics in the diet (or via supplementation), you’ll be helping your gut recover from the traumatic experience of dealing with antibiotics. However, some people may find that they are left with nagging symptoms even after incorporating probiotics and prebiotics. In this case, it’s very important to test for common conditions like dysbiosis and SIBO.

References:

1) Pharmaceutiques, Universitad Catholique de Louuain. “Dietary modulation of the human colonie microbiota: introducing the concept of prebiotics.” Journal of Nutrition 125 (1995): 1401-1412.

2) Gibson, Glenn R., et al. “Dietary modulation of the human colonic microbiota: updating the concept of prebiotics.” Nutr Res Rev 17.2 (2004): 259-275.

3) Chow, JoMay. “Probiotics and prebiotics: a brief overview.” Journal of Renal Nutrition 12.2 (2002): 76-86.

4) Bouhnik, Yoram, et al. “Short-chain fructo-oligosaccharide administration dose-dependently increases fecal bifidobacteria in healthy humans.” The Journal of nutrition 129.1 (1999): 113-116.

5) Davis, L. M. G., et al. “A dose dependent impact of prebiotic galactooligosaccharides on the intestinal microbiota of healthy adults.” International journal of food microbiology 144.2 (2010): 285-292.

6) Bouhnik, Y., et al. “Lactulose ingestion increases faecal bifidobacterial counts: a randomised double-blind study in healthy humans.” European Journal of Clinical Nutrition 58.3 (2004): 462-466.

Why I Don’t Take a Diet-First Approach to Healing Gut Issues

You might assume that, as a dietitian who works with those with digestive problems and gut microbiome imbalances like SIBO and dysbiosis, I spend the majority of my time counseling my clients on diets like the low-FODMAP diet, SCD diet, GAPS, or any other number of restrictive dieting approaches out there.

Want the truth?

I spend the majority of my time talking to my clients about things other than the types of foods they’re eating. We talk antimicrobial herbs, stress reduction, sleep, exercise, calorie intake…but specific food choices? We don’t spend much time on those beyond general healthy eating concepts.

In my 7 years of working with digestive health clients, I’ve found that taking a diet-first approach to fixing microbial imbalance in the gut is the wrong move.

Here’s why.

Restrictive Diets Don’t Address the Real Problem

If you have gut issues like SIBO or dysbiosis, heavily restricting your diet doesn’t solve the problem. I’ve written about this concept specifically in regards to a low-FODMAP diet before, but it applies to practically every other restrictive dietary approach out there. The only exception to the “rule” would be the elemental diet (which I don’t even consider to be a “diet” per se; rather, it is a supplement food alternative), which is quite effective in clearing SIBO.

You can’t “starve” bacteria while you’re eating real food. Sure, when they’re not getting enough fiber or prebiotics, they’ll become somewhat dormant and symptoms will dissipate. But bacteria aren’t going away or being killed off by a restrictive dietary approach.

This is something I’ve talked about before quite a bit, but it really does bear repeating given the massive amount of misinformation I see floating around the internet. There are health gurus out there promoting dietary changes as the way to get rid of bad bacteria in the gut.

Unfortunately, this is simply not true and ends up making people wait to get real treatment (i.e. antimicrobials or antibiotics) for the microbial issues.

It is necessary to actually kill off and get rid of bad bacteria, parasites, candida to feel better, and you can’t do that with diet alone.

Restrictive Diets Aren’t Necessary For Results

You might already know that diets don’t kill off bacteria, but still believe that a restrictive diet is a key element to a gut-healing protocol.

I used to think the same thing myself! I had clients following strict elimination diets, thinking that I was helping them to reduce inflammation and get them results faster than if they were just following a generally healthy diet.

But what I found was that my clients eating really restrictive diets and those who were following a much more liberal approach both got great results as long as they were balancing their microbiome, supporting their health in other ways, and keeping in mind their own personal dietary “triggers”.

That meant using targeted antimicrobial herbs or antibiotics to push out any unwanted bacteria, supporting digestion with digestive enzymes, demulcent herbs, probiotics, prebiotics, etc, focusing on sleep and stress, eating enough, exercising appropriately, and finding time to spend with family and friends and do the things they love.

It also involved identifying any major dietary triggers and keeping those out of the diet. Note that these are triggers that are extremely obvious to the person without having to do any sort of dietary restrictions to figure out.

It became rather clear to me at that point that if I could get my clients the same great results without having them go on a super restrictive diet, why on earth wouldn’t I do that?

These days, I’m recommending a pretty liberal diet (more on that below) to my digestive health clients and we’re still getting rid of bloating, excessive gas, diarrhea, constipation, and abdominal pain. No restrictive diet required.

If I can make the healing process just a little bit easier for my clients, I’ll do it all day every day. They are grateful to not have the added frustration, complication, and expense of eating an incredibly strict diet when they don’t have to and they still get the same end result: no more digestive issues.

Restrictive Diets Make You More Likely to Undereat

One of the biggest issues I have with really restrictive dietary approaches is that they make it so much more likely that my clients are going to accidentally eat less than they should. When you cut out a lot of foods and don’t have many choices to replace them with, chances are you’re going to undereat relative to your needs.

When you’re trying to heal and nourish your body, the last thing you should be doing is feeding it less than it needs. Undereating can lead to symptoms like irritability, moodiness, low blood sugar, hormonal problems, sleep issues, and more. My friend Laura Schoenfeld, RD goes into more detail on a lot of these symptoms and how they’re related to undereating here.

And this not something to think about just from a calorie and macronutrient perspective, either. When you’re on a restrictive diet, it’s also much easier to skimp on important vitamins and minerals that come from some of the foods you’re restricting.

Micronutrient deficiencies can lead to lots of health problems as well — so again, when you’re trying to heal your body, undereating becomes a massive problem.

Instead, I make sure my clients know how much food they should be eating to properly fuel their body and help them eat a diverse, nutrient-dense diet.

Restrictive Diets Mess with Your Relationship with Food

I can’t tell you how many people I’ve worked with who are just truly afraid of food. They get worried about every symptom they experience and spend a ridiculous amount of time trying to trace every symptom to a food they ate.

It makes for a really messed up relationship with food.

I have to spend a lot of time educating them that the root cause of these symptoms is more likely to be an imbalanced gut (and the resultant inflammation) than specific foods they’re eating. That inflammation can cause digestive issues regardless of the foods they’re eating.

When you’re dissecting your diet for potential problematic foods, all food becomes a potential “trigger” for the negative symptoms you experience instead of a source of nourishment and pleasure.

This mindset also tends to lead to further and further restriction. Someone might start off by just limiting FODMAPs, but then they read about other potential food triggers and take those out, read about other triggers and take those out, and the cycle continues until they’re barely eating any foods at all.

By only using more restrictive dietary approaches when they are truly necessary, you can avoid damaging your relationship with food and view food as a nourishing, pleasurable thing instead of something that is attacking your body.

Dietary Restrictions Distract from Other More Important Changes

When you’re so focused on diet, you’re less likely to pay attention to (what I would consider) the heavy-hitters like stress, sleep, exercise, and social relationships.

After all, we only have so much we can think about and dedicate ourselves to. When diet takes up a huge amount of our headspace, it’s easy to forget about these other, less “sexy” topics.

I’d argue that these other changes are more important things to focus on than diet (provided that you’re eating a relatively healthily). When my clients stop spending all their time focusing on what they’re eating and instead start paying more attention to their sleep quality, stress management, and exercise habits, they feel better than they ever have before.

Focusing less on diet also gives you more time to focus on yourself and your community. You can spend time enjoying your hobbies, or socializing with friends and family. Research has shown that social relationships play a huge role in our health, and that as society, we’re getting lonelier. Laura and I have talked about the importance of social relationships in the past and how prioritizing social relationships over diet can actually improve your health and well-being.

It might sound strange to hear a dietitian say this, but…there is so much more to life (and health) than food. Don’t let yourself get caught up in the idea that diet is a cure-all, and don’t let diet distract you from all the other healthy habits you could be incorporating into your healing regimen.

Long-Term Restrictive Diets May Negatively Impact Your Health

Most clinicians know that restrictive diets like the elimination diet should really only be used as a short-term therapy while we’re working on fixing the underlying root causes of your health issues.

But when patients start implementing these diets on their own and put off treating root causes of their problems, they often end up staying on restrictive diets for years. This can happen even if they are also treating the root cause of their issue, simply because they become too afraid to reintroduce foods once they start feeling better (see above).

Researchers are concerned about the health implications of staying on restrictive diets for the long-term, like changes in the microbiome, nutritional inadequacy, and fostering disordered eating habits.

While the jury is still out about the true consequences of long-term restrictive eating, those reasons alone are enough to give me pause.

If I can stop someone from getting on the restrictive diet train (and still get them results, of course), I’ll do it in a heartbeat.

Is a Restrictive Diet Ever the Right Choice?

There’s definitely a time and a place for a more restrictive diet, I just don’t believe it’s at the beginning of someone’s health journey (for most people).

The only time I might recommend an elimination diet or other restrictive approach right from the start is if someone has extreme health issues that are incredibly disruptive to their day-to-day life in a way that does not allow them to function. This might mean someone who is having diarrhea 8-10 times per day and can’t work because of it, or someone whose abdominal pain makes it so that they can’t even think about anything else because they’re constantly in pain. Of course, in situations like these, getting symptom relief is priority #1 and if we can do that in a way that isn’t necessarily fixing the root issue but is faster, that makes more sense.

But those with milder issues may never come to the point of needing a more restrictive diet. As I mentioned above, a restrictive diet isn’t necessary for most people to see great results. But if you’ve re-balanced your microbiome (and tested to make sure you’ve actually cleared out any bad bugs), addressed nutrient deficiencies, sleep, stress, exercise, socialization/community, and you’re still having some digestive problems or other health issues…that’s when you might want to consider taking out some additional foods to see if you have a true sensitivity that’s causing some of your problems.

If you’re going to implement any kind of restrictive diet, I highly recommend working with someone to do so, as there needs to be a solid reintroduction strategy that is incorporated after a short-term restrictive diet to avoid the potential health consequences of a long-term restrictive approach.

If I Don’t Need to Restrict… What Should I Do?

If you have digestive issues, the first thing you need to do is test your gut bacteria to determine if your microbiome is imbalanced. This is the top cause of digestive problems!

From there, you need to actually address the issue. That means getting on an antimicrobial protocol or taking antibiotics, using probiotics and prebiotics and other supplements to help balance your microbiome. Remember — this is typically the root cause of digestive issues (among other health issues), not your food.

Beyond that, you’ll want to put a strong emphasis on stress management, getting good sleep, exercising appropriately, eating enough, and prioritizing social relationships.

This is what I cover in my Build Your Biome program.

But from a diet perspective, I simply recommend focusing on general healthy eating principles. If you’re familiar with a real food, Paleo, Primal, or Weston A. Price way of eating, these principles will be very familiar to you.

If you’ve been caught up in restrictive dieting, this diet is going to look like it’s full of “triggers”. Please remember that you’ve now been conditioned to think this way — to view food as the enemy rather than something that can nourish and heal you.

Here are the things I focus on when it comes to diet for my clients:

  • Eat Real Food
    • Less processed food, more real, whole food
    • Organic, non-GMO as much as possible (especially for dirty dozen foods)
  • Limited Restrictions — just the things that I really think make a difference.
    • Take out any major triggers for that individual (remember, these are super duper obvious and don’t require an elimination diet to figure out)
    • Swap industrial seed oils for better fats (as much as possible — most people won’t be able to take them out entirely)
    • Reduce sugar intake (though I don’t require my clients to take out sugar completely)
    • Reduce alcohol consumption
    • Take out gluten (not always, but I do recommend this somewhat often)
  • Be Grateful for Your Food
    • This is especially important if I have clients coming from a more restrictive diet — I actually tell them to create a “mantra” of sorts to remind them that food is nourishing and healthy. They might repeat something like this to themselves at meal time: “This food will help nourish and heal me.” We also focus on mindful eating habits like paying attention to the smells and taste of their food.
  • Eat Enough
    • As we discussed above, eating enough is vital to the healing process, so I make sure that my clients are eating enough to fuel their body. This means getting enough calories overall, as well as making sure their macronutrient breakdown makes sense for the type of activity they are doing.
  • Balance Blood Sugar
    • Blood sugar surges and crashes can lead to HPA axis dysregulation, along with a host of symptoms like moodiness, anxiety, and hormonal symptoms. Making sure my clients have well-balanced blood sugar is crucial.
    • This typically means combining carbohydrates with fats and proteins, as well as consuming enough fiber, to help regulate blood sugar.

That’s it! Simple, easy, and just focuses on the things that will really make a difference. We don’t worry about FODMAPs, dairy, grains, or legumes (all things taken out on elimination diets quite frequently) unless it’s clear foods within those categories cause problems for that particular client.

I’ll admit that this way of practicing is quite different from how most digestive health experts practice. Heck, I’m sure I’ll get some flack for this article.

But at the end of the day, what matters to me most is that I get my clients results in the easiest way possible while making sure they have the capacity to focus on things beyond diet that are important for overall health.

So let me ask you: how restrictive is your diet and how long have you been following that approach?

Probiotics: An In-Depth Guide & The Best Probiotic Supplements on the Market

probiotic

Probiotics have thundered onto the health and wellness stage — you hear about them everywhere now.  With claims running the gamut from “probiotics heal your gut” to “probiotics prevent cancer,” it seems as though they are just about a cure for everything.

But, do they actually do what they claim to? Or are these claims just another way to convince you to buy expensive supplements?

In this article I’m going to answer all of your pressing questions about probiotics. From the very basics of what probiotics are, through the details of probiotic strains, to the ways probiotics work at the molecular level; everything you need to know about this burgeoning field, you’ll find right here.

What are Probiotics?

Alright, first thing’s first. What are probiotics, exactly?

According to the Food and Agriculture Organization of the United Nations and the International Scientific Association for Prebiotics and Probiotics, probiotics are defined as: “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.” (1)

…And what, exactly, does that mean?

Well, basically, it means a probiotic is any species of bacteria, virus, fungus or tiny parasite that, if you get enough of them living on or in your body, makes you healthier. You can kind of think of these microorganisms as “reverse germs”. If they “infect” you, rather than getting miserable cold or flu symptoms, they make you feel extra healthy for a while.

Even though this is the official definition, when most people say “probiotic”, this isn’t exactly what they mean. They usually aren’t talking about the microorganisms directly; rather they are talking about products that contain these microorganisms — probiotic supplements. Probiotic supplements are capsules, pills, tablets, powders, lotions, liquids or even foods that have had probiotic microorganisms mixed in. (1)

That means when you hear people talking about how they’re “taking a probiotic”, they’re usually talking about taking a capsule or pill filled with probiotic microorganisms.

I realize that, in a lot of ways, this is a tiny distinction. After all, it’s the microorganisms that are the defining feature in both cases. But it’s helpful for being able to really visualize what the people in your life mean when they are talking about probiotics. And it helps you understand the way scientists, who stick to technical definitions, are using the term when you’re poking around in scientific literature.

I told you! We’re covering all our bases here!

What Do Probiotics Do?

So, now we know that probiotics are microorganisms that make you healthier. Cool!

But how does that actually work? What do probiotics actually do that leads to you becoming healthier?

That is an excellent question!

To really explain it, we’re going to have to make a small detour here and talk about something called the gut microbiome.

Introduction to the Gut Microbiome

The gut microbiome is the name scientists give to the collective host of trillions of microorganisms that naturally live in the human digestive tract. (2)

Yep. Whether you know it or not, your gut is loaded with microorganisms. Most of them are bacteria, but there are also viruses, fungi and other tiny single-celled organisms. (2) Your intestine is a veritable jungle of microscopic life!

And it’s supposed to be.

I know it feels pretty weird to think about because we’re so programmed to think of bacteria and viruses as gross and dangerous, but your gut is intended to function completely filled with microorganisms. Not just any microorganisms, though. These are microorganisms hand-selected over millions of years to be the perfect gut-buddies for humans. (3, 4)

I Feed You, You Protect Me: The Mutual Benefits of the Gut Microbiome

There are few relationships in nature as truly symbiotic (scientific slang for “win-win”) as that between you and your gut microbiome.

For your microbiome, this is the best gig ever. The bacteria living in your gut have a permanent, perfectly climate-controlled environment.  It’s balmy 98.6℉, all day, every day. They always have enough water. Food simply rains down on them three times a day. And when other germs show up and want to steal their cushy gig, their home literally helps kill them off.  (5, 6)

For you, your microbiome provides an ingenious solution to a serious problem: the overwhelming onslaught of potentially dangerous microorganisms coming in from the digestive tract.

The world is absolutely positively overrun with microorganisms. Everything you see, touch and eat is swarming with bacteria, viruses and all kinds of other little critters. You microbiome, thankfully, helps you kick out bad bacteria without it making it into your bloodstream to infect you.

Symbiosis to Dependance: Extensive Functions of a Healthy Gut Microbiome

As you might imagine, with such a good gig for both us and the bacteria, neither of us was planning to go anywhere. We got cozy, our gut bacteria settled in, and we started building a serious partnership that ran far deeper than just food and protection.

We started relying on one another, expecting one another to be there, and organizing our physiological functions around one another. This has gone on to the point that we are now really and truly dependent on one another for our health, wellbeing and survival. (6, 3, 4)

For our gut bacteria, this means that many of them can no longer thrive anywhere but in our guts.

And, for us, it means that we can no longer regulate our vast array of complex organ systems without gut bacterial help. Over the millennia, we’ve come to rely on our gut bacteria to properly (6, 3, 4, 7, 8, 9, 10, 11):

  • Digest food
  • Maintain our intestinal walls
  • Coordinate our intestinal wall movements
  • Regulate our immune system function
  • Coordinate nerve signaling and brain function

We need them in order for our body to work at all normally. And when we don’t have them, we become ill.

Probiotics and the Gut Microbiome

So what do probiotics have to do with the gut microbiome?

Well, probiotics are part of your microbiome.

When you take a probiotic supplement, the probiotic microorganisms are transported down to your digestive tract. Naturally, they take to it like a fish to water. They grow, divide and thrive.

They take up the mantle of microbiome responsibility – supporting digestion, gut health, immune health, nervous system health and, thereby, your whole body health. (6, 12, 13)

Probiotic Benefits

I guess, technically, I could leave the benefits of probiotics at “support[…] digestion, gut health, immune health and nervous system health,” couldn’t I?

But that’s a bit vague and impractical if you’re trying to decide if probiotic supplements are a good fit for you. It’s much more helpful if I break it down into individual symptoms. So, that’s exactly what I’m going to do!

Here are some of the main benefits of probiotics (that have been proven so far, anyway!).

1. More Regular Bowel Movements.

At first glance, this probably seems like more of a “convenience benefit” than a “health benefit”. But unhealthy bathroom habits can actually have serious consequences for your health. (14, 15, 16, 17)

For example, regular constipation (having hard to pass stools or less than three bowel movements per week) increases your risk of a painful and potentially life-threatening hernia, not to mention upping the odds of developing colon cancer. (14, 15)

Having extremely frequent bowel movements (more than three times per day), though, is also not healthy. Regular diarrhea puts you at risk of dehydration, electrolyte imbalances and nutrient deficiencies. (16)

What you want is to pass firm but soft stools, without straining, around once a day. (17) That offers you the best opportunity to absorb all the water and nutrients you need without increasing your risk of damaging your intestinal health.

Probiotics help you keep this healthy one-per-day rhythm by stimulating your enteric nervous system. (18, 19, 20)

Your enteric nervous system is responsible for generating the waves of muscle contractions that push your food from your stomach, down through the intestines, and out into the toilet. Strong, even, regular muscle contractions keep food moving smoothly and your bowel movements regular. (20, 18, 21)

2. Less Bloating and Flatulence

No need to explain how this one is a health benefit! Less belly cramps, bloating, belly aches and gas — I’m sold!

The bacteria in your gut microbiome break down bits of food you don’t absorb for their own food and make gases in the process. Healthy gut bacteria in the right place (in the large intestine, not small intestine) make fewer gases (though, not none!), reducing bloating, belly aches and flatulence.

By helping keep your gut stocked with healthy bacteria (and free of dangerous bacteria — see point 3!), probiotics can limit gas production and ease the associated digestive symptoms. (2, 22, 23)

3. Fewer Gut Infections

I bet you’re not surprised to see probiotic benefit number three — after all, keeping dangerous microorganisms at bay is kind of the whole point of the gut microbiome!

Adding probiotics to your gut helps your microbiome (24, 25):

  • Soak up nutrients and hog all the physical room in your gut, so dangerous microorganisms can’t set up a home
  • Produce organic acids that harm dangerous microorganisms
  • Produce antibiotic molecules to kill invaders

Together, these effects are potent enough to prevent and treat infections like E. coli (which can cause severe diarrhea and a fever) and H. pylori (which can cause stomach pains similar to gastric reflux, gastric ulcers and stomach cancer). (24, 25, 26, 27, 28)

More probiotic microorganisms, less gut infections!

4. Less Systemic Inflammation

Let’s move out of the gut and talk about the health benefits of taking probiotics on the rest of your body.

One of the most important, if not the most important, of these benefits is reducing systemic inflammation in your body.  

When your gut bacteria are out of balance, toxic molecules called lipopolysaccharides (LPS) makes it into your bloodstream, causing system-wide inflammation.

By helping to balance your microbiome, probiotics keep levels of LPS lower, thus reducing inflammation. (29)

Probiotics also help your gut microbiome calm your immune system, reducing inflammation. They do this by activating a group of cells called Treg cells in your gut, which move throughout your body and calm overactive immune cells. (30, 31, 32, 33, 34)

And reducing systemic inflammation is a huge deal for your health! Studies have clearly linked total body inflammation to multiple very serious conditions, including (35):

  • Obesity
  • Heart Disease
  • Diabetes
  • Dementia
  • Osteoporosis
  • Cancer

By easing systemic inflammation, probiotics can reduce your risk of all of these conditions.

5. A Healthier Body Weight

Yep, you read that right! Probiotics can help you lose weight. And help you keep it off, too. (36, 37)

This is probably partially due to the effect on systemic inflammation I just mentioned. Systemic inflammation messes with your metabolism and makes it more likely that you will put on weight and have trouble getting it back off. (38)

There may also be more direct effects as well. Healthy gut bacteria, like those in probiotics, don’t liberate as many calories from your food as unhealthy bacteria do. That means that boosting a healthy gut microbiome with probiotics may result in you getting fewer calories from the exact same meal. (39)

You can read more about the microbiome and the metabolic system in my article here.

6. Healthier Blood Sugar Levels

Researchers believe the improved blood sugar control from taking probiotics is due mostly to the reduction in systemic inflammation I mentioned above. (40)

Systemic inflammation makes it extremely difficult for insulin to do its job in your body, driving blood sugar up.  Elevated blood sugar levels, long-term, puts you squarely on the path to type 2 diabetes and other metabolic diseases. (40)

7. Less Plaque Build-Up in Your Arteries

Probiotics can modify two of the risk factors for developing plaque in your arteries: high cholesterol and high blood pressure. (41, 42, 43)

Probiotics can bind cholesterol from your food right in your gut, keeping it from getting into your bloodstream. This lowers the total amount of cholesterol in your blood, helping keep it from building up in your arteries and forming a plaque. (43, 44)

Probiotics also help release blood pressure-lowering phytoestrogens (“plant estrogens”) from the food they were in, so that they can be absorbed more efficiently and bring your blood pressure down. (45, 46, 43)

Combined, these two effects of probiotics can help protect your arteries and reduce your risk of having a heart attack or stroke.

8. Stronger Bones

Not itching to break a hip when you get older? Probiotics might help you out here, too!

As with nearly everything on this list, part of this benefit comes from the reduction in systemic inflammation that accompanies probiotics. Nipping the inflammation process in the bud can really help protect your bones.

Additionally, probiotics can help make sure your bones have all the nutrients they need to be rigid and strong. Probiotic microorganisms produce folate and vitamins D, C, and K, all four of which are super important for your bone health. Probiotics also help to break down foods in your gut, freeing up minerals like calcium so you can absorb more of them, too. (47)

Less bone breakdown and more bone-building nutrients — an excellent combination for life-long healthy, strong bones.

9. Decreased Autoimmunity

Autoimmune diseases are awful. Caused by your immune system attacking your own healthy tissues, they are painful, debilitating and, usually, really hard to treat.

Probiotics, though, may be able to offer some relief to those struggling with autoimmune symptoms. (48)

Probiotics help prevent your gut from becoming “leaky”, a serious risk factor for developing an autoimmune disease. The reasons for this are a little complicated, but, basically, a leaky gut lets too many foreign molecules into your body. This increases the risk your immune system will become overwhelmed, get confused, and start attacking the wrong things! (Check out my article on autoimmunity and gut health to learn more about how this works.)

If this weren’t enough, probiotics also help your gut microbiome produce specific molecules, called short-chain fatty acids (SCFAs) and histamine which can directly quell an overactive immune system. (49, 50)

10. Improved Reproductive Health

Trying to start a family? Or just want to make sure your sexy-time says healthy? Probiotics might come in handy, here, too.

For men, probiotics may be useful because they can reduce plaque buildup in their arteries… all their arteries. Blood flow to the penis is really important for male sexual health, which means so is having healthy arteries for the blood to flow through is, as well. By keeping men’s penile arteries plaque-free and able to let large amounts of blood flow as it should, probiotics can help prevent erectile dysfunction. (51, 52, 53, 54, 55)

For women, probiotics may be able to help prevent vaginal infections. Not only is this important for keeping sex from being cancelled altogether until the infection clears up, studies indicate that it is also important for having a healthy pregnancy. Women with active vaginal infections are at a higher risk of miscarriage. So, preventing infections, perhaps with a probiotic, before conception and during pregnancy is probably a good idea. (56, 57)

11. A Happier Mood

A more balanced mood, fewer feelings of stress and a generally sunnier outlook — all in the power of a probiotic, too!

Research now clearly shows that taking a probiotic can improve your mood, even effectively helping combat serious mood disorders, such as clinical depression. (58, 59)

This is thought to be because a healthy gut microbiome helps regulate the amounts dopamine and serotonin (“happiness hormones”) in your brain. They do this partly by helping the brain produce more of them on its own. But your microbes actually produce some for you, too! Really, they manufacture them for you in your gut, you absorb them, and then use them in your brain to help keep you happy. (60, 61)

Probiotic Side Effects

Probiotic side effects are fairly rare and usually mild. If you do experience side effects taking probiotics, it is usually a slight increase in digestive discomfort, such as mild worsening of your bloating or flatulence. In most cases, these symptoms resolve on their own after a few days, if you continue to take your probiotic normally. (62)

The only serious side effect associated with probiotics — an infection of the bloodstream with the probiotic microorganism — is extremely rare. There are a few conditions that you could have, however, that might make your risk of infection a touch higher.

If you have the following conditions, probiotics might be a bit riskier for you and you should speak to your doctor before taking them: (63)

  • A very weak immune system (if you have an HIV infection or are undergoing chemotherapy, for example)
  • Short bowel syndrome
  • A central venous catheters
  • Cardiac valve disease  

So, Are Probiotics Safe?

The short answer here is: yes! Scientists and doctors all generally agree that probiotics are very safe to take. (62)

The only exception could be if you have one of the conditions I mentioned above or if they are given to very, very young infants (whose immune system isn’t fully formed, yet). (63)

If you have any concerns about taking a probiotic, please speak to your doctor, pharmacist or nutritionist. They can talk to you about your concerns and your medical history and determine whether probiotics are a good fit for you, personally, or not.

Best Probiotic Supplements

It would be really nice if each and every one of these health benefits came from the exact same probiotic microorganism. Unfortunately, each member of your gut microbiome has a unique role in helping you stay healthy. So, different microorganisms are more effective at providing specific health benefits than others.

Why Probiotic “Strains” Are Important

Most probiotic supplements on the market today only give you their probiotic species information rather than their strain.

What’s important to know, though, is that probiotic strains dictate their effect, meaning that one strain of a probiotic can have a completely different effect on your body than another probiotic strain. (64) A supplement that only tells you its probiotic species vs its strains isn’t giving you a whole lot of information and it’s very, very possible that the supplement could be totally useless for what you’re trying to achieve.

I’ve written an entire article on this topic and highly suggest reading it if you’re currently taking a probiotic supplement. It will give you a completely different outlook on probiotics and show you exactly what to look for.

Below, I’ve listed the probiotic strain(s) with the strongest evidence for each health benefit, along with reputable probiotic supplements where applicable.

Best Probiotics for Digestive Health

Most probiotic and digestive health research has focused on irritable bowel syndrome. This is a functional digestive disorder with severe, but common, digestive symptoms, including constipation, diarrhea, abdominal cramps, gas and bloating.

To date, the best probiotic strains found for relieving IBS symptoms was the combination of:

  • Bifidobacterim breve (DSM 24732)
  • Bifidobacterium infantis (DSM 24737)
  • Bifidobacterium longum (DSM 24736)
  • Lactobacillus acidophilus (DSM 24735)
  • Lactobacillus delbrueckii subsp. bulgaricus (DSM 247634),
  • Lactobacillus paracasei (DSM 24733)
  • Lactobacillus plantarum (DSM 24730)
  • Streptococcus thermophilus (DSM 24731).

This exact combination has been tested in three double-blind, randomized, controlled trials and a single open-label trial, and all four found significant improvements in IBS symptoms. (65, 66, 67, 68)

Whether each of the strains would be helpful by themselves is not really known. But, that’s okay! You can actually buy this exact combination yourself under the brand name Sigma Tau VSL#3.

Lactobacillus plantarum 299v has also been shown to improve the symptoms of IBS and can be found in Jarrow’s Ideal Bowel Support supplement. (69)

Best Probiotics for Weight Management

The probiotic strain with the strongest evidence supporting its use to reduce weight is Bifidobacterium lactis B420. In a double-blind, placebo-controlled, randomized trial, B. lactis B420 helped overweight and obese patients lose 4% of their body weight in 6 months. (70) You can get this probiotic strain in Metagenics’ Ultraflora Control supplement.

To maintain weight and prevent new weight gain, studies suggest that the eight strains from Sigma Tau VSL#3 may be a better bet. (71)

Best Probiotics for Healthy Blood Sugar Levels

If you’d like your probiotic supplement help you to regulate your blood sugar levels, Lactobacillus acidophilus La5 and Bifodobacterium lactis Bb12 are the two best strains available. Multiple studies confirm these bacteria are able to lower blood sugar and A1c levels, even in those already struggling with diabetes. (72, 73)

A supplement containing both these strains is Standard Process Prosynbiotic.

Lactobacillus casei Shirota can also attenuate the development of insulin resistance when humans consume a high fat diet, which is known to be detrimental to the microbiome and human health. (74)

You can find this strain in the Yakult line of products.

Best Probiotics for Your Arteries

To reduce your cholesterol and protect your arteries, studies point to Lactobacillus reuteri NCIMB 30242. This probiotic microorganism was able to lower people’s total cholesterol by 9% and their LDL, specifically, by over 11%. (75)

You can buy this strain in Microbiome Plus Gastrointestinal Probiotics L Reuteri NCIMB 30242 GI Digestive Supplements.

If you’re more concerned about lowering your blood pressure to protect your arteries, Lactobacillus helveticus strains, particularly Lactobacillus helveticus LBK-16H and Lactobacillus helveticus CM4, are good choices. (76, 77) When these strains are combined with milk, they produce blood pressure lowering peptides. See the chart below for the impressive benefits seen with L. helveticus strains. (78)

lactobacillus

Lye, Huey-Shi, et al. “The improvement of hypertension by probiotics: effects on cholesterol, diabetes, renin, and phytoestrogens.” International journal of molecular sciences 10.9 (2009): 3755-3775.

Unfortunately, there do not appear to be any products on the market (yet) that contain these exact strains of Lactobacilluls helveticus.

Best Probiotics for Your Bones

The Lactobacillus helveticus species seems to be very helpful for bone health. (79) Unfortunately, studies rarely report the actual strain used. And, when the do, the strains are not identical in every positive study, suggesting many Lactobacillus helveticus species may be effective.

This is our current problem within probiotics research — researchers haven’t been great about keeping track of the strains they’ve used thus far, and many studies focus on species versus strains. However, recent research indicates that it is the strain level that is most important in determining the effect of the probiotic and now researchers are starting to document their strain choices in their research to better help us, as consumers, know which strains might benefit us.

So let’s hope there will be some follow-up studies on probiotics for bone health (and other conditions!) that detail the strain used so that companies can start using these strains in their supplements for a healthier way to treat health conditions.

Until we have more data about individual strains, it’s tough to say whether supplementing with simply any Lactobacillus helveticus strains would be helpful. However, if you’re looking for bone health benefits and are okay with knowing that it’s somewhat unknown whether this particular strain would help or not, you can try Life Extension’s Florassist Mood, which contains Lactobacillus helveticus R0052.

In studies on mice, Lactobacillus rhamnosus GG (found in the Culturelle supplement, among others) and the strain combination found in VSL #3 have also proven to be useful for bone health. (80)

Best Probiotics for Autoimmune Conditions

The best probiotic for preventing and managing autoimmune conditions appears to depend on the exact autoimmune condition you’re looking to address.

For example, rheumatoid arthritis appears to respond to Bacillus coagulans GBI-30 6086 or a combination of Lactobacillus rhamnosus Gr-1 and Lactobacillus reuteri RC-14. (81, 82)

Ulcerative colitis, on the other hand, improves with Escheria coli Nissle 1917, Lactobacillus plantarum 299v, the combination of the nine strains of VSL#3, and Bifidobacterium longnum BB536 (83, 84, 85, 86, 87, 88, 89, 90), while psoriasis responds to Bifidobacterium infantis 35624. (91)

Unfortunately, we don’t have clinical trials for many autoimmune disorders at all. Since the effective probiotics are so different between disorders, it’s also really difficult to extrapolate and make educated, helpful suggestions without studies.

It is best to talk to your doctor about which probiotic strains she thinks might be helpful for you and your autoimmune disorder, personally. This is absolutely critical if you are taking immunosuppressants to control your symptoms, as this could put you at higher risk of infections with probiotic microorganisms. Do not start taking a probiotic if you are on active immunosuppressants without speaking to your doctor.

If you happen to be dealing with symptoms of rheumatoid arthritis, ulcerative colitis or psoriasis and have gotten the okay from your doctor, supplements you might want to check out are:

Best Probiotics for Your Mood

Human trials suggest Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 are an effective strain combination for improving mood and reducing anxiety. (92)

You can get both of these probiotics in a single supplement with Pure Encapsulations Probio Mood or Life Extension Florassist Mood.

Best Probiotics for Women (Reproductive Health)

Lactobacillus rhamnosus Gr-1 and Lactobacillus reuteri RC-14 are, currently, the best strains researchers know of for preventing bacterial vaginosis and women’s reproductive health. (93, 94, 95, 96, 97)

You can get these strains in Jarrow Formulas Fem Dophilus Probiotic Supplements.

Best Probiotics for Men (Reproductive Health)

Since one of the key reproductive benefits you can reap from probiotics as a man is improved artery health (and penile blood flow) the best probiotics here are the same as those for artery health: Lactobacillus reuteri NCIMB 30242 and Lactobacillus helveticus spp. (98, 99, 100, 101, 102)

A supplement on the market that contains one of these strains is Microbiome Plus Gastrointestinal Probiotics L Reuteri NCIMB 30242.

Unfortunately, as you’re seeing throughout this article, the Lactobacilluls helveticus strains need to be detailed in the research being done so that consumers can be sure that the strains used in their supplements are actually helping their condition.

Probiotic-Rich Foods

Not sure you’re feeling the idea of taking a full-blown probiotic supplement? You can also get probiotics from your food. In general, the foods richest in probiotics are going to be fermented foods. (103)

Humans have been making and consuming fermented foods since the development of civilization. (104) By fermenting foods, we were able to preserve our food for later consumption without it going bad.

Probiotic-rich foods include:

  • Kombucha
  • Yogurt
  • Kimchi
  • Sauerkraut (refrigerated, if you’re buying it in the supermarket)
  • Kefir
  • Miso
  • Pickles or pickled vegetables (again, refrigerated)
  • Kvass

Much of the “hype” around fermented foods these days has been in regard to their probiotic content. However, fermented foods have a whole lot more going for them than “just” probiotics.

As part of the fermentation process, fermented foods produce other beneficial compounds such as short-chain fatty acids and antimicrobial and anti-inflammatory end-products. (105) This is in addition to any vitamins, minerals, and nutrients they contain as a whole food.

Probiotic Foods vs. Supplements

To begin this section, I’ll simply say that neither is “better” than the other; really, you should be consuming both!

Fermented foods that contain probiotic cultures provide a host of benefits, including (of course) probiotic bacteria and the other beneficial compounds I just mentioned above.

Fermented foods are typically studied as a whole food rather than their specific probiotic strains or beneficial compounds, so when researchers see humans benefit from fermented food consumption, it is unclear as to whether they are responding to the probiotics or the other healthy compounds contained in the food (or both, which is the most likely scenario).

With probiotic supplements, we can be more specific in the strains we are choosing, thus conferring specific benefits. As you’ve seen throughout this article, certain strains are useful for particular conditions, so if there is something specific you’d like help with it’s usually best to take a strain that has shown to be beneficial for that condition (in addition to regularly consuming fermented food).

That said, companies are adding well-researched strains to fermented food products, so it may be possible to get the best of both worlds. For example, the Lactobacillus casei Shirota strain (found in the Yakult probiotic drink) is a highly-researched strain that is useful for many different conditions, such as dysbiosis and weight gain prevention. (106, 107)

Ideally, I like to see my clients consuming both fermented foods and probiotics for maximum benefit, especially if they have specific health complaints or family history that they’d like to address.

If you’re completely healthy and you have no health conditions that you’re looking to prevent or improve, just consuming fermented foods may be all you need. But looking at the research on specific probiotic strains, it becomes very clear to me that you gain a lot of benefit from adding probiotic supplements to your routine in addition to regular fermented food intake, especially if you’ve got a health condition or a propensity to develop a health condition.

How Often Should I Take Probiotics?

Probiotics, whether they be in supplement or food form, should be consumed on a daily basis. When you take probiotics exogenously, they don’t stick around in the gut for a long time. Because of that, it’s important that you are regularly consuming them for maximum benefit.

So include fermented foods with your meals and set a reminder to pop your probiotic pill each day!

What if I Don’t Tolerate Probiotics?

Do you feel sick when you take probiotics? Perhaps you get digestive discomfort, or maybe you get high histamine reactions like flushing or hives.

If you don’t tolerate probiotics for any reason, it’s a sign that you may have dysbiosis (imbalanced gut bacteria) that needs to be addressed.

It’s imperative that you balance your microbiome for optimal health; just taking probiotics won’t get rid of all the bad bacteria in your gut in most cases if it’s already overrun (although they do really help!).

Want to know how to tell if you have imbalanced gut bacteria? Read my article on the topic here.

Wrapping It Up

Probiotics have a host of benefits, including promoting digestive health, regulating your immune system and protecting your metabolic health.

Probiotics are safe, with a minimal chance of side effects. They are also effective, as long as you choose the right probiotic strain for the health benefit you are looking for.

Fermented foods are also a great way to get probiotics in your diet (although you lose the benefit of knowing you’re taking a strain that is specific to your health condition). For best results, eat fermented foods and take a probiotic supplement regularly.

The Truth About Leaky Gut Syndrome: What is It and How Do You Heal?

leaky gut syndrome

Is leaky gut syndrome real? Here’s what you need to know about this condition, how it affects your body, and how to heal for good.

Please note: there are affiliate links throughout this post. If you buy products through those links you help to support more great content like this!

What is Leaky Gut Syndrome?

Think about your digestive system for a second — from mouth to anus, it’s really just one long tube that dictates what can be absorbed into your bloodstream and what passes through the body. It knows that things like nutrients and water are important to absorb into the bloodstream, while toxic particles and undigested foods should make their way to the large intestine to be passed out of the body in the form of stool.

The gut barrier is one single cell layer thick and is connected by “tight junctions” that hold the cells together. This single layer of cells and the tight junctions between them are the only things preventing harmful particles from entering your bloodstream.

When the gut is functioning normally, these tight junctions hold the cells that make up your gut barrier together and only allow small particles (like nutrients) into the bloodstream.

Leaky gut syndrome, or increased “intestinal permeability,” is when the tight junctions holding the cells of your gut barrier together don’t function properly and the cells drift apart, allowing larger molecules like bacteria, undigested food particles, and waste products into the bloodstream.

Think of the gut barrier like a strainer. It only lets things of a certain size pass through, while anything too big will be kept out. Now imagine the holes in your strainer getting bigger, thus allowing larger particles through. That’s exactly what’s happening to your gut when you have leaky gut syndrome.

When you have leaky gut, your body is bombarded with unrecognized particles like lipopolysaccharides (LPS) that are present on the outer membrane of bad bacteria as they make their way through the bloodstream. Your immune system goes into high alert to try to protect you from these toxic particles, and as a result, you develop a high amount of inflammation.

This high level of LPS in the blood is associated with many conditions, as you can see below.

Rodriguez-Castaño GP, Caro-Quintero A, Reyes A, Lizcano F. Advances in Gut Microbiome Research, Opening New Strategies to Cope with a Western Lifestyle. Frontiers in Genetics. 2016;7:224. doi:10.3389/fgene.2016.00224.

I’ve written more about microbial imbalance and the resulting inflammation, and how that contributes to disease (specifically metabolic disease) in this article.

Is Leaky Gut Real?

There’s a lot of controversy over the term “leaky gut,” particularly the use of the term “leaky gut syndrome,” which seems to indicate that this condition is an official medical diagnosis.

Leaky gut syndrome is not a medical diagnosis, however, leaky gut is indeed a very real phenomenon that is seen throughout the scientific literature. Leaky gut is simply the more colloquial term for increased “intestinal permeability” or “intestinal hyperpermeability,” which are the terms you’ll see most often in the scientific research. (Though the term “leaky gut” is even catching on in research, and you’ll see that now too!)

In fact, at the time of this posting, there are over 90,000 Google Scholar results for the term “intestinal permeability”, and as you’ll see throughout the rest of this article, intestinal permeability is associated with a vast array of diseases and conditions.

What Causes Leaky Gut?

While there’s a lot we’re still learning about leaky gut, there are a few things we know of already that can cause this syndrome.

Gut Microbiome Imbalance (Dysbiosis)

Having an overload of bad gut bacteria (or dysbiosis) is one of the top causes of leaky gut syndrome. That’s because these bad bacteria have a toxic molecule on their outer membrane called lipopolysaccharide (LPS) that is highly inflammatory.

LPS causes gut inflammation, which causes the cells of the gut barrier to pull further apart, leading to leaky gut syndrome.

When you have both leaky gut and dysbiosis, the LPS that causes leaky gut then gets into the bloodstream, taking inflammation to the rest of your body and putting your immune system on high alert.

You can read more about dysbiosis and how it contributes to leaky gut and other diseases here.

Stress

Stress is also a huge factor when it comes to leaky gut syndrome. Researchers have known for a long time that severe physical stress such as trauma or surgery causes the intestinal lining to become “leaky”, but more recent research has started to look at the effect of chronic psychological stress on the gut barrier.

To approximate chronic psychological stress in humans, rats are repeatedly subjected to water aversion stress where they are placed on a platform surrounded by water. Researchers have found that this is a mild stressor to the rats, similar to the type of chronic mild stressors we face today. So what happens to these rats? They develop intestinal permeability that takes several days of no stress to heal.

This mild, chronic stress directly causes the cells of the gut barrier to drift apart, which, as discussed earlier, allows toxic particles to filter through into the bloodstream.

In addition to this, stress also imbalances gut bacteria, which also leads to the development of leaky gut syndrome in and of itself.

Certain Pharmaceutical Drugs/Alcohol

Certain drugs like NSAIDs (e.g. aspirin and ibuprofen, among others) are known to cause leaky gut. Alcohol also has the same effect.

However, it should be noted that it is chronic, excessive use of these items that leads to major intestinal permeability, so don’t worry if you like to enjoy a glass of wine or need to take an aspirin every once in a while!

That said, if you’re actively trying to heal from leaky gut (and not just trying to prevent it), it’s a good idea to limit your alcohol intake and avoid using NSAIDs as much as possible.

Diet

Diet plays a very important role in digestive health. An unhealthy diet, high in sugars and unhealthy fats while low in fiber, can lead to the development of leaky gut syndrome. This is because an unhealthy diet encourages the growth of bad gut bacteria. Unfortunately, this is common on a Standard American Diet (SAD).

In addition to eating unhealthily, consuming foods that you are allergic or sensitive to can also lead to irritation and inflammation in the gut and intestinal permeability.

Leaky Gut Symptoms

According to the scientific literature, there are a number of conditions that are associated with increased intestinal permeability, both within the digestive system as well as outside of it.

These conditions include:

    • Ulcers
    • Diarrhea
    • Irritable bowel syndrome (IBS)
    • Inflammatory bowel diseases (IBD — ulcerative colitis and Crohn’s disease)
    • Celiac disease
    • Cancer, esophageal and bowel
    • Allergies
    • Infections
    • Acute inflammation
    • Chronic inflammation
  • Obesity-associated metabolic disease

Now, this does not necessarily mean that leaky gut itself causes these conditions, just that intestinal permeability is commonly seen in these conditions.

However, there is research that indicates that leaky gut is present before the development of disease which makes researchers believe that it may be a “requirement” of sorts to develop various diseases.

However, it has given researchers a lot to think about as they explore leaky gut treatment possibilities to help prevent, treat, or reverse some of these conditions. I, for one, am very excited to see where the science leads us.

Testing for Leaky Gut

Leaky Gut Tests on the Market

There are two common tests for identifying leaky gut: differential sugar tests (like the lactulose mannitol test) and the zonulin test.

Differential sugar tests (DSTs) are considered the “gold standard” in leaky gut testing. For this test, you drink a solution containing specific sugars and then the levels of these sugars are measured a few hours later in your blood or urine. The idea here is that large oligosaccharides, like lactulose, do not pass through the gut barrier, while small monosaccharides, like mannitol, do. By testing for the sugars in the bloodstream or urine after consuming them, you’re able to see the degree of intestinal permeability that is present.

Testing for zonulin in the blood is, unfortunately, not a great way to determine if you have leaky gut. Zonulin levels do not seem to correlate with other markers of intestinal permeability (like the DSTs mention above), and zonulin levels are constantly changing, making one single measurement of this protein a fairly useless measurement of intestinal permeability.

Testing for zonulin antibodies, on the other hand, may prove a more useful measurement.

If you want to test for leaky gut, a differential sugar test or a zonulin antibody test is your best bet.

But that brings us to our next question… Is testing for leaky gut even worth it?

Is it Worth Testing for Leaky Gut?

I’m going to cut right to the chase here and say… No.

I’m not a big fan of testing for leaky gut because it never changes how we’re going to address it.

Truth is, there’s always something else causing leaky gut, like bad gut bacteria (dysbiosis), a poor diet, stress, food intolerances, etc.

So I’d much rather test for or evaluate those areas of my client’s lives than test for leaky gut.

Because, really, if I see someone who has digestive issues or an autoimmune disease or any of the conditions I mentioned above that are associated with leaky gut, I’m 99% sure that they have leaky gut anyway. I don’t necessarily need a test to tell me that because it’s not going to change how I approach the situation.

Instead of testing for the “symptom” (leaky gut), you want to test for the root cause (gut bacteria, stress, diet quality). Because when I know that a client has dysbiosis and their diet isn’t great and they have a stressful job, addressing all of those things is what is going to heal their leaky gut.

Save your money for gut bacteria testing instead of spending it on leaky gut tests!

Healing Leaky Gut

Now, just because testing for leaky gut is somewhat pointless doesn’t mean you shouldn’t treat leaky gut. As I hope you realize by now, leaky gut is indeed a real phenomenon that is important to address.

You may have heard that you can take supplements alone to heal leaky gut, but the crux of a leaky gut syndrome treatment plan tackles gut microbial imbalance, diet, and stress (with supplements to help along the way).

Leaky Gut Treatment Plan

The Leaky Gut Cure: Balancing Your Microbiome

The #1 cause of leaky gut is an imbalanced microbiome (dysbiosis). It is absolutely vital that you determine if you have bad gut bacteria and balance your microbiome if you want to cure leaky gut.

If you find you have imbalanced gut bacteria through SIBO testing or stool testing, you must get rid of that bad bacteria in order to heal leaky gut.

This is done by using herbal or pharmaceutical antimicrobials, dietary changes, stress reduction, and more. You can read more about how to get rid of bad bacteria here.

If you want to learn more about bacterial imbalance and how to fix it, I encourage you to take my free training by clicking the image below!

leaky gut syndrome

Leaky Gut Diet

As mentioned previously, a Standard American Diet full of unhealthy fats and sugars and low in fiber is a recipe for disaster when it comes to leaky gut.

Researchers are also worried about the impact of processed food additives, like emulsifiers and solvents, on our gut barrier, so avoiding processed foods is a good idea.

The best thing you can do from a dietary perspective to heal leaky gut is to eat an organic, nutrient-dense, whole foods diet that is high in fiber and prebiotics and low in unhealthy fats and sugars. You can read more about my dietary philosophy when it comes to supporting a healthy gut here.

The best foods to heal leaky gut include:

    • Non-starchy vegetables (broccoli, cabbage, leafy greens, etc)
    • Starchy vegetables (potatoes, sweet potatoes, yucca, taro, squash, etc)
    • Fruits (bananas, oranges, berries, apples, etc)
    • Meats (beef, pork, chicken, duck, etc)
    • Seafood (oysters, scallops, shrimp, sardines, etc)
    • Healthy fats (Olive oil, avocado oil, animal fats, etc)
    • Nuts (walnuts, macadamias, almonds, etc)
    • Legumes (if tolerated — lentils, beans, chickpeas, etc)
  • Dairy (if tolerated — yogurt, cheese, etc)

As much as possible, choose organic foods to avoid pesticides and additives. When trying to heal from leaky gut, it’s also wise to limit the amount of alcohol you consume.

Repair a Leaky Gut with Stress Management

Chronic stress induces intestinal permeability, so it’s imperative on any leaky gut treatment plan to incorporate stress management techniques.

Deep breathing, meditation, chi gong, yoga and more are options, but really, any stress management technique that you enjoy and are likely to do on a regular basis is best!

I find that my clients benefit more from practicing these techniques for shorter periods of time more often (for example, 5-7x/week) than doing a long session, say, once a week.

Best Supplements for Leaky Gut

There is a lot of really promising research looking at the best supplements for leaky gut, but it’s important to remember that supplements do not negate the need to address things like dysbiosis, diet, and stress.

You can take a million supplements for leaky gut, but if you’re not addressing those main causes of intestinal permeability, supplements really won’t get you very far. As much as I would love to tell you otherwise, there is no magic pill.

Supplements are used to “supplement” an existing treatment plan; they can help speed up the process of healing or make it easier, but they themselves won’t cause any lasting change on their own.

Antimicrobials Kill off Bad Gut Bacteria

It is clear that imbalanced gut bacteria, or dysbiosis, plays an enormous role in the development of leaky gut.

Because of that, it’s absolutely necessary to kill off bad bacteria and encourage healthy growth of beneficial microbes.

Most often, getting rid of bad bacteria is going to require being on antimicrobials of some kind (whether they are herbal or pharmaceutical).

As a dietitian, I’m a big fan of herbal antimicrobials. Here are some of my favorites to use:

    • Oregano oil (found in Biotics Research ADP — I like this one in particular because it’s a time-released oregano supplement)

Probiotics for Leaky Gut

Probiotics, in general, have proven to be very helpful in restoring and maintaining proper gut barrier integrity.

However, we need to remember that probiotic effects are strain-specific, so it’s important to pay attention to the exact strains that have been shown to be helpful (so that if you buy a probiotic to take, you know you’re getting a strain that actually has been proven to improve leaky gut!).

Here are the best probiotics for leaky gut:

Prebiotics for SCFA Production

Prebiotics are a powerhouse when it comes to healing leaky gut. It has been shown that supplementing with prebiotics reduces LPS concentrations in the blood. Remember that LPS is the toxic molecule on the outer membranes of bad gut bacteria. When you have a permeable gut, more of this toxic particle gets into your bloodstream and wreaks havoc from there. So when researchers are trying to determine whether a substance reduces leaky gut or not, they can look at the amount of LPS that ends up in your blood.

Now, prebiotics are different from probiotics. You can think of prebiotics as the food or fuel for probiotics; in essence, they feed your good bacteria so that you have plenty of the good guys around.

In addition to this, prebiotics also increase your production of short-chain fatty acids (SCFAs) which help to heal and seal the gut barrier as well as reduce inflammation (since less inflammatory LPS particles are getting through to the bloodstream).

My favorite prebiotics include:

A quick note about the Sunfiber supplement is that, unlike other prebiotics like GOS or FOS, Sunfiber is low-FODMAP and thus does not tend to increase digestive symptoms like bloating or gas like higher-FODMAP choices do. It also mixes really easily with water or other liquids, so it’s super easy to take.

Quercetin Seals a Leaky Gut

Quercetin is a really useful tool for helping to heal leaky gut. In fact, I’ve written a whole article on the topic!

We’ve already discussed the fact that stress increases intestinal permeability. Part of how this happens is that stress “destabilizes” or “degranulates” mast cells.

You may have heard of mast cells before as the cells responsible for allergy symptoms, like congestion, runny nose, etc. This is because when mast cells “degranulate” or become “unstabilized,” they release histamine, the chemical that causes allergy symptoms.

But you have mast cells all throughout your gut too, and when they “degranulate” or become “unstabilized” there, they cause leaky gut.

So how does quercetin fit into the picture?

Quercetin is one of the most abundant flavonoids present in our food supply, found in high amounts in onions, kale, and apples. It is well-known for many things, including its anti-allergy properties, anti-cancer effects, and as an antioxidant. But did you know that it can heal leaky gut too?

Since intestinal permeability is caused (at least in part) by unstabilized mast cells in the gut, it makes sense that quercetin would have this effect. This is because quercetin stabilizes mast cells and prevents the release of histamine and other chemicals from these cells. When researchers breed rats to have no mast cells in the gut (thus they are unable to have unstabilized mast cells that release histamine), they no longer develop intestinal permeability.

Quercetin has also been shown to enhance gut barrier function by having a “sealing” effect due to its role in the assembly and expression of tight junction proteins. Tight junctions regulate our intestinal permeability by connecting intestinal cells, thus only allowing the nutrients that we need in and keeping everything else out.

As you can see, adding quercetin to your leaky gut supplement protocol can really do a lot to help keep that gut barrier sealed up!

There are plenty of quercetin supplements on the market, but one of my favorites is the Source Naturals Activated Quercetin supplement.

Collagen Repairs a Leaky Gut

Collagen is the most abundant protein in our body, and is found in high amounts in the gut. It is also a potent source of the amino acid glycine.

As humans, we are meant to eat a mix of both glycine and methionine (among other amino acids), but in the modern world where we don’t tend to eat nose-to-tail, that can be difficult. You see, glycine is abundant in animal products that we don’t usually consume, like tendons, ligaments, and bone while methionine is present in high amounts in muscle meat (think steak, chicken breast, etc). This altered ratio of methionine:glycine intake is thought to be related to our increase in chronic disease rates. I highly recommend watching Denise Minger’s Ancestral Health Symposium talk on this topic.

Because of its role in the gut, collagen peptides have been found to heal leaky gut by improving tight junction function.

There are many collagen peptide supplements on the market right now, but I’m a big fan of the Vital Proteins line.

L-Glutamine Fuels Gut Cells

Glutamine is an amino acid and is a major fuel source for intestinal cells.

It has been studied and used for years in relation to its ability to reduce intestinal permeability in critically ill patients.

In addition to this, glutamine supplementation can also improve gut bacteria balance.

This gives you a great combination of benefits: glutamine balances your microbiome and heals leaky gut.

While capsules may seem like the easiest to take, you’re actually better off getting a powder for supplementation. This is because you’re generally going to want fairly high doses of glutamine to get the benefits for leaky gut.

In healthy adults, the observed safe level of l-glutamine is 14g/day. Considering that most capsules contain a maximum of about 1000mg, you’d have to take 14 of them every day!

Therefore, an L-glutamine powder is a much better choice for leaky gut.

Vitamin D Keeps Your Gut Healthy

Vitamin D is one of those vitamins that you sit and wonder… “What can’t Vitamin D help with?!”

From bone health to the immune system, Vitamin D plays a role in almost every facet of our being — and that includes preventing and healing leaky gut.

You see, Vitamin D deficiency makes you more likely to have leaky gut. The good news, however, is that supplementing with Vitamin D can keep your gut barrier in good condition.

You can get Vitamin D from sun exposure, food, and supplementation. Getting proper sun exposure is the best way to get your Vitamin D, of course! There are very few foods that contain a lot of Vitamin D, so it’s somewhat difficult to get your D from your diet.

If you’re not getting enough sun exposure to get adequate Vitamin D, your next best bet is to supplement.

I recommend taking a Vitamin D3 supplement. Depending on your current blood levels, taking anywhere from 2000 – 5000 IU per day is a good idea.

And because fat-soluble vitamins work synergistically, I recommend taking a combination supplement that also includes Vitamin K2, like Thorne’s Vitamin D/K2 Liquid.

Zinc Improves Gut Barrier Integrity

Zinc is an important mineral that is used in a variety of processes within the body to keep us healthy.

When you’re deficient in zinc, your body’s ability to heal wounds may become impaired, your immune system may not function as well, and you might develop anemia, hypogonadism, or mental illness.

In addition to this, your gut barrier may become impaired. Zinc supplementation has been shown to improve gut barrier integrity in those with Crohn’s disease. It does this by strengthening the tight junctions that hold the cells of the gut barrier together.

I like to incorporate zinc into any leaky gut supplement protocol for these reasons. Zinc carnosine is my favorite form of zinc for leaky gut as it’s been shown to heal leaky gut and help repair gut cells.

I like Integrative Therapeutics’ Zinc Carnosine supplement.

How Long Does It Take to Heal Leaky Gut?

As I mentioned before, treating leaky gut requires a multi-pronged approach. You need to get rid of bad gut bacteria, manage your stress, and eat well. Supplements can help you do these things, but they’re not the end-all-be-all of leaky gut treatment.

When people ask this question, what they really mean is “How long will it take before I feel better?” That can really depend.

If you have an autoimmune disease and believe leaky gut is playing a role in that, the truth is you may never fully recover from autoimmunity. That said, healing your gut can improve your symptoms immensely. I’ve seen symptom improvement in as little as a month, while others can take 6 or more months to really see significant benefits.

If you have digestive issues that you think are caused by leaky gut, I’ve found that healing your gut goes a long way toward recovery. Just as with autoimmune diseases, I’ve seen significant improvement in as little as a month when really addressing all aspects of a leaky gut treatment plan.

When it comes down to it, how long it will take you to heal leaky gut totally depends. It depends on how long you’ve been dealing with gut issues, how much you’re able to commit to the changes that need to be made to heal your gut, and then it’s just about how your body (we’re all different, right?) responds.

The short answer: on average it can take anywhere from 1-6 months to actually feel better when you’re trying to heal from leaky gut (though it may take longer for your gut barrier to completely repair).

Heal Leaky Gut For Good

While I hope this article has given you a lot to start thinking about, if you want to learn exactly how to address digestive issues, I’d like to invite you to join my free training.

You’ll learn:

    • How to fix digestive issues even if you feel like you’ve tried everything before
    • How to determine the cause of digestive issues and heal them for good
  • How to overcome food sensitivities

I’ll go into more detail on the gut bacteria imbalances that cause leaky gut (remember you have to get rid of those bad guys if you ever want to heal leaky gut!).

Want to join me? Click the image below to sign up!

leaky gut syndrome

Why Probiotic “Strains” Are Important & The Best Probiotic Strains on the Market

best probiotic strain

Did you know that the strain of a probiotic determines its effect? And that most probiotic supplements don’t tell you what strain they contain? In order to take the best probiotic for you, you need to understand which strain will give you the benefits you’re looking for.

What is a Probiotic?

No doubt you’ve heard all the hype about probiotics.

“Probiotics will heal your gut!”

“Probiotics will prevent food sensitivities!”

“Probiotics treat IBS!”

…among others.

There’s a million claims out there and a million more probiotic supplements to buy. So how do you know what the best probiotic supplement is?

Before we jump into that, let’s quickly define probiotics:

Probiotics, at their most basic definition, are “live microorganisms which when consumed in adequate amounts as part of food confer a health benefit on the host” (according to the World Health Organization).

What is a Probiotic Strain?

Probiotic strains are where things get a bit more complicated.

You see, most of us are used to seeing probiotic names listed on labels with two parts to the name.

For example, you might see “Lactobacillus rhamnosus” on a supplement label and nothing more than that. Looks pretty legit, right? It’s a complicated name that most of us probably wouldn’t pronounce correctly.

But the truth is that it’s missing the most important part of its name — its strain.

Probiotic effects are strain specific. That means that you can’t expect Lactobacillus rhamnosus GG to do the same things as Lactobacillus rhamnosus PB01. Those third letters/numbers (e.g. “GG” and “PB01”) are the strain of the bacteria and are extremely important when you are evaluating the best probiotic supplement for you.

For example, Lactobacillus rhamnosus GG is a highly-studied strain that has a whole host of benefits, including preventing antibiotic-associated diarrhea, C.difficile treatment, and promoting intestinal barrier function.

On the other hand, Lactobacillus rhamnosus PB01 is mostly studied for urogenital infections in women, sperm motility, and pain.

So if you’re looking for a probiotic to prevent diarrhea while you’re on an antibiotic, should you really be taking a probiotic that has mostly been studied to help get rid of a urinary infection or improve sperm motility? Absolutely not!

The best probiotic for you is going to be different from the best probiotic for someone else.

heal your gut

 

Probiotic Naming

When it comes to probiotics, you generally need to look at 3 different parts of the name.

The first part (e.g. Lactobacillus) is the genus.

The second part (e.g. rhamnosus) is the species.

And the third — most important — part (e.g. “GG” or “PB01”) is the strain.

When looking at a probiotic supplement you’re about to buy or take, you must make sure that it lists the strain, not just the genus and species.

Why Probiotic Strain Matters

Without knowing the strain of the probiotic you’re taking, it’s impossible to know the effect that a probiotic might have on your health.

And when you’re spending your hard-earned money, don’t you want to know exactly what you’re paying for?

While your husband might benefit from the sperm-motility-enhancing effects of Lactobacillus rhamnosus PB01, you might be better served by the leaky-gut preventing aspect of Lactobacillus rhamnosus GG.

Makes a big difference, doesn’t it? 

Remember: the best probiotic for you won’t be the same for someone else.

Choosing the Best Probiotic Supplement for You

In order to pick the best probiotic supplement for yourself, you now know that you need to look for the strain of probiotic that your supplement contains.

But more often than not, you’ll simply see up to the species level on a probiotic label. So you might see “Lactobacillus rhamnosus” on the label instead of “Lactobacillus rhamnosus GG”.

Now, I hope that these supplement companies are just ignorant instead of blatantly trying to dupe their customers.

But the truth is that you need the strain information in order to make a decision about the best probiotic supplement for yourself. And if the probiotic company that you’re trying to buy from doesn’t list it and won’t tell you, chances are that it’s a poorly-studied strain, or doesn’t do what they’re advertising it does.

If you’re looking at a probiotic supplement and the strain isn’t listed, you can contact the company and ask what strain they’re using. But don’t be surprised if they tell you that their probiotic mixture is “proprietary” (i.e. they don’t want to tell you what’s in it).

If that’s the case, I recommend steering clear. They either don’t want you to know that they’re using a poorly-researched strain of probiotics or they’re simply ignorant to the fact that the strain of probiotic really matters and determines the benefit that you’ll receive as the consumer. I usually want to give these companies the benefit of the doubt, but honestly, if you’re making a probiotic supplement you should know this stuff is important.

Let’s go through an example.

Take a look at the supplement facts for Klaire Labs Therbiotic Complete supplement below:

probiotic strain

You’ll notice that there are only two words for each type of bacteria, indicating that we’re getting to the species level, not the strain level.

We’ve talked about Lactobacillus rhamnosus strains throughout this article, and as you can see above, they just list “Lactobacillus rhamnosus” without telling us whether it’s Lactobacillus rhamnosus “GG”, “PB01”, or any other number of Lactobacillus rhamnosus strains. Who knows!

I reached out to Klaire Labs to see if they’d tell me the strains included but — surprise! — that’s “proprietary information”:

probiotic strain

I can only hope that Klaire Labs will get their act together if they want to serve their customers well.

On the other hand, take a look at the label for Florastor:

probiotic strain

We are clearly getting to the strain level by going beyond “Saccharomyces boulardii” and to “Saccharomyces boulardii CNCM I-745”. They did a great job by actually putting it on the label so you don’t even have to contact the company to see exactly what strain you’re getting. (P.S. this is a well-researched strain that I highly recommend, especially for preventing antibiotic-associated diarrhea.)

Another supplement I like and use a lot, Culturelle, also lists their strain on the label (though they do so in a somewhat confusing way):

probiotic strain

Here we see “Lactobacillus GG” written, so while they’ve given us the strain (“GG”), they don’t include the species level. I am guessing this is for space concerns on the label, but I wish they’d include all three parts of the name so that people don’t get confused.

However, you can rest assured that they are actually giving you the strain name. Sometimes you might also see strains listed with their copyrighted name, like “LGG®” (that’s the copyrighted name for Lactobacillus rhamnosus GG).

heal your gut

The Best Probiotic Supplements that Actually Tell You Their Strains:

I realize that after learning this, you might feel a bit overwhelmed at the idea of finding a probiotic supplement that actually lists its strains and those strains are appropriate for you.

So here’s a list of the best probiotic supplements in my book (in no particular order), along with a few reasons why I might use them.

Someday I hope to add my own supplement to this list because, truly, we need more choices for quality probiotic supplements. Might have to step up and take things into my own hands!

Culturelle (Lactobacillus rhamnosus GG)

I use Culturelle in clients who have IBS-like symptoms (gas, bloating, diarrhea, constipation, abdominal pain, etc), as well as those who are currently on antibiotics or those who have dysbiosis.

Florastor (Saccharomyces boulardii CNCM I-745)

I use Florastor with clients who are taking antibiotics, or who have diarrhea, SIBO, giardia, candida, blastocystis hominis or H.pylori. It’s a favorite of mine!

Jarrow Ideal Bowel Support (Lactobacillus plantarum 299v)

I love Jarrow Ideal Bowel Support for those with IBS-like symptoms like excessive gas, bloating, diarrhea, constipation, abdominal pain, and more.

Now Foods Clinical GI Probiotic (Bifidobacterium lactis HN019, among others)

I use Now Foods Clinical GI Probiotic in those who have dysbiosis or who I think have slow motility. It is also useful for metabolic issues and helps your immune system.

Quick note about some formulations with multiple strains (including this one): Take a look at the label below and you’ll see that the supplement contains a mix of strains, but the label just says there is a total of 20 billion CFUs (how they measure the amount of bacteria). This does not tell us how much of each particular strain there is, and we want to know that there are at least 1 billion CFUs per strain to get a beneficial effect.probiotic strain

Given that the supplement label is not clear enough to tell us if each of these strains is present above 1 billion CFUs, I would only use this supplement if you’re looking to get the HN019 strain and consider all other probiotics “bonuses” since it’s impossible to know how much you’re getting.

Metagenics UltraFlora Synergy (Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07)

Metagenics UltraFlora Synergy is also great for preventing antibiotic-associated diarrhea, so it’s a good choice if you’re on antibiotics.

It’s also useful in dealing with bloating and abdominal pain, as well as improving the balance of your gut microbiome. In addition to this, is great for your metabolic system and insulin sensitivity.

Note: This is an example of a multi-strain probiotic that tells you how much of each strain there is, unlike the Clinical GI probiotic above. We see on the label that there are a total of 15 billion CFUs and it also tells us that it is a 50:50 split between the two strains present.

probiotic strain

Solgar Advanced Multi-Billion Dophilus (Bifidobacterium lactis Bb12, among others including L. rhamnosus GG)

Solgar Advanced Multi-Billion Dophilus is also very useful for preventing antibiotic-associated diarrhea, as well as preventing constipation. It is also helpful for improving blood glucose levels.

Note: This is another example of a multi-strain probiotic that tells you how many CFUs are present for each strain. In fact, I like this label the best since it lists the exact number of CFUs for each individual strain.

Visbiome (Lactobacillus acidophilus DSM 24735, Lactobacillus paracasei DSM 24733, Lactobacillus delbrueckii bulgaricus DSM 247634, Bifidobacterium breve DSM 24732, Bifidobacterium infantis DSM 24737, Bifidobacterium longum DSM 24736, Streptococcus thermophilus DSM 24731)

Visbiome is a highly-researched strain blend that is very potent. This probiotic supplement can be used for IBS, ulcerative colitis, antibiotic-associated diarrhea and more.

The Bottom Line

As you can see, knowing the particular strain of probiotic that you’re taking is extremely important. Without knowing it, you have absolutely no idea what benefits (or potential detriments) that strain might offer.

Probiotic effects are strain-specific meaning that one strain of a species might have completely different effects on a person than another strain.

Because of this, it is vital that you know what strains you’re buying and also that the strain you’re buying has the effect that you’re looking to get! This allows you to choose the best probiotic supplement for you.

Without knowing this, you might be throwing money down the drain by taking expensive supplements that haven’t been well-researched and don’t give you the results you’re looking for.

So consider this your PSA: Don’t buy probiotics without knowing the strain you’re buying!