Chances are, if you get a prescription for antibiotics, your physician has also recommended probiotic-rich yogurt or a probiotic supplement to reduce the risk of getting diarrhea. At the same time, you might be wondering whether you should follow the advice from friends, family and popular culture to take probiotics for everything from a healthier gut to a healthier brain.
“Probiotics are essentially additional bacteria that are either adding benefit or reestablishing benefit to what your body has,” explains Joshua Pullo, Pharm D, clinical adjunct faculty member in the University of Florida College of Pharmacy in Gainesville and a practicing community pharmacist. Pullo says he answers questions about probiotics from his customers daily.
Boosting Good Bacteria
The bacteria we are most familiar with are those that make us ill. When you take an antibiotic to kill these “bad” bacteria, the antibiotic can also kill your native “good” bacteria, and that can lead to diarrhea.
“Your doctor is trying to restore healthy bacteria back into the gut after they get decimated by antibiotics,” explains Shira Doron, MD, infectious disease physician and antimicrobial steward at Tufts Medical Center in Boston.
Healthy bacteria live throughout your body, and those in the digestive tract play an important role as helpers in our digestion, according to the National Center for Complementary and Integrative Health. This population of bacteria in your body is often called your “microbiome.”
5 (Probable) Benefits
Research has only supported a handful of health benefits related to taking probiotics, and the Food and Drug Administration (FDA) has not yet approved probiotics for use in treating any specific condition. Probiotics have been shown to help with:
1. Antibiotic-related diarrhea
“This is really the only thing probiotics have definitive evidence that they help,” says Pullo. Your physician might recommend taking probiotics during and after an antibiotic regimen.
2. Diarrheal conditions
Traveler’s diarrhea and diarrhea related to other gastrointestinal conditions, including inflammatory bowel disease, might be improved with probiotics, says Pullo, but the research isn’t definitive. Probiotics could help people with irritable bowel syndrome (IBS) experience less pain, according to research published in the March 2015 issue of the World Journal of Gastroenterology.
People with ulcerative colitis might find a benefit from the VSL#3 blend of probiotics, according to research published in the September 2014 issue of Inflammatory Bowel Disease.
3. Enhancing mood and brain health
Research into the impact of probiotics on your mood and brain is ongoing, but experts theorize that increasing the diversity of your gut microbiome could blunt depression and anxiety, according to a review published in the June 2016 issue of Molecular Psychiatry.
4. Preventing sepsis
Taking probiotics appears to reduce the risk of blood infections known as sepsis, according to Pinaki Panigrahi, MD, PhD, professor of pediatrics at the University of Nebraska Medical Center in Omaha. The results of his team’s research were published in the August 24, 2017, issue of Nature.
5. Reducing respiratory infections
In addition to testing whether probiotics could reduce sepsis, Dr. Panigrahi and his team also found, to their surprise, that probiotic also reduce the of risk respiratory infections, and reported that in the same issue of Nature cited above.
Researchers are still working on studies to find out whether probiotics can improve other conditions, such as allergies, eczema, and the risk of cognitive decline with age.
Although the FDA hasn’t approved probiotics to treat anything, probiotics are generally considered safe. We found 3 aspects of probiotics that you need to be aware of:
The biggest drawback to taking probiotics regularly is cost, says Pullo. At the high end, you might be paying $50 to $60 for a month’s supply. He adds that refrigerated probiotics generally cost more than shelf-stable products, but that shelf-stable probiotics can be just as beneficial.
2. Risk for people with weakened immunity
When the Agency for Healthcare Research and Quality (AHRQ) commissioned a review of studies of probiotics to assess risks, they found very few adverse events with the exception of certain groups of people, including the very young and very elderly, and people who are immune-compromised because of health conditions such as an autoimmune disease or severe burns, or medications, such as chemotherapy treatments or immune suppressants. Pullo points out that some people might feel more gas and bloating if they start taking a lot more probiotics quickly.
3. Numbers matter
Read product labels to make sure the product offers enough probiotics. The numbers of these tiny probiotics can be mind-bogglingly large, but research suggests that you might need one million for daily maintenance and upward of 10 million to address a specific issue, such as diarrhea, for a formulation to be effective, says Pullo. That’s to address a specific issue, such as diarrhea, says Pullo, adding that one million is sufficient for daily maintenance.
There are numerous probiotic products on the market, and many other edible items that claim to have probiotics. Our experts provided these tips for savvy shopping:
1. Pharmacists are helpful
Your pharmacist can answer questions about probiotics and your specific health concerns, as well as order products that you might want to try but are not usually carried in the pharmacy.
2. Don’t feel pressured
Advertising and the pressure of friends can lead you to believe you need specific products. But, says Dr. Pullo, you’re better off taking your pharmacist’s advice. Consider the common wisdom that a refrigerated probiotic will be more effective than a shelf-stable one. Dr. Pullo points out that refrigerated products are more costly, but you aren’t always buying any increased effectiveness with those extra dollars.
3. Be savvy about labels
“Probiotics are not regulated like drugs,” points out Doron. That means you have to read the labels to find out what strains are included and how many of those strains are in the mix. For example, lactobacillus strains have generally been shown to be effective with diarrheal conditions, so you might want to look for those as part of a blend if you’re fighting or preventing diarrhea. Also, beware of health claims on the bottle or from the company. Ask for the research behind those claims or check the internet for more information, says Panigrahi.
4. Try, try again
Each probiotic product might contain a slightly different blend, so Pullo recommends trying a second probiotic blend if the first one hasn’t worked well for you.