How Should I Take Probiotics?

Image Credit: Eric C Bryan / Flickr. This image has been modified.

How Should I Take Probiotics?

Foods appear to be better carriers for probiotics than supplements, but if one chooses to go with the supplement route, should they be taken before, during, or after meals?

The package labeling on probiotic supplements is often confusing. Sometimes the consumer is instructed to take the probiotics with meals, sometimes before or after meals, and occasionally on an empty stomach. I was surprised to find so few actual data in the scientific literature concerning this topic, but that is par for the course for most dietary supplement advice. See, for example, my video series about how little pharmacists and natural food store employees know:

The lack of information on how to take probiotics has led to serious confusion, both for the industry and the consumer. Surprisingly it doesn’t appear as if any studies had ever examined this question–until now.

Researchers hoped to be able to measure probiotic concentrations throughout the entire process after taking a probiotic supplement minute-by-minute.  To do this, they had to build a fake digestive track with a fake stomach and intestines, but complete with real saliva and digestive enzymes, acid, bile, and other digestive fluids. What did they find? If you check out my 2-min video Should Probiotics Be Taken Before, During, or After Meals?, you can see the survival of three different types of probiotics before, during, and after meals. You can also see how the probiotics fared when taken in oatmeal and milk, milk alone, apple juice, or water.

What did they find? Like vitamin D supplements, which should also probably be taken with meals for maximum efficacy (Take Vitamin D Supplements With Meals), probiotic bacterial survival was best when provided within 30 minutes before or simultaneously with a meal or beverage that contained some fat content.

This study didn’t shed light on what dose we should take and under what circumstances, however. To see what the best available science says, see the first video in this series, Preventing and Treating Diarrhea with Probiotics. Then I compared probiotics to prebiotics in Preventing the Common Cold with Probiotics? and moved to the effect of your gut flora on your mood in Gut Feelings: Probiotics and Mental Health.

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


20 responses to “How Should I Take Probiotics?

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  1. I know milk and its products according to you block the absorption of antioxidants. Does that apply to yogurt as well? I have read many times that the best probiotic is yogurt. Your thoughts?

    N. Allen

    1. Yogurt only carries one or two probiotics and they have been mostly killed so they don’t reproduce and blow the lid off the container. Probiotics grow fast in the presence of sugar including the sugar in milk.

    2. Norman123: Yo might consider checking out “water kefir” and maybe rejuvalac. Both can be made a home and are supposed to provide a great deal of helpful probiotics. And neither come with all the harmful effects one gets from consuming dairy.

      (For more on the harm caused by dairy:
      http://nutritionfacts.org/topics/dairy/
      )

      Something to think about.

    3. The dairy in milk can block vitamin absorption. Probiotics are not vitamins, they a living bacteria cells that your intestines need to digest food properly. The best way to have a healthy balance of probiotics is to just eat a variety of fruits and veggies in your normal diet and keep off junk the food. Your stomach acid will kill most of the probiotics you take if you take it in pill form anyways… So save your money and pick up some broccoli.

  2. It seems like earlier Dr. Greger was saying to just eat fruits and vegetables because they have some lactic acid, but doesn’t the amount of lactic acids and probiotics multiply when you make sauerkraut? Some people are saying probiotics are expensive. Making sauerkraut is very easy and incredibly cheap! Want to get your veggies in? Make sauerkraut. Does having different species in the sauerkraut give you a broader portfolio of probiotics? I often put in daikon radish, onion, carrot, cabbage, red cabbage (antioxidants), napa cabbage, cauliflower, broccoli, kale, etc. It makes a wonderful dressing for my nightly salad.
    John S
    PDX OR

  3. I disagree with Dr. Greger and the conventional wisdom (the majority of probiotic supplement makers) that it’s better to make an effort to increase the survival of lactobacilli and bifidobacteria through the highly acidic human stomach.

    People who agree with this strategy should either (1)swallow enteric-coated probiotic capsules, which will not melt open until after they have moved beyond the human stomach or (2)swallow their nonenteric-coated probiotic capsules during large meals, when the contents of the human stomach will be less acidic (have a higher pH).

    My belief is that it’s better to chew all probiotic capsules in our mouth. The reasons are: (1)Lactobacillus rhamnosus has been shown to easily survive inside the human stomach and to colonize it. People who have Lactobacillus rhamnosus thriving on the inner lining of their stomach will have a very dramatically lower risk of developing gastric cancer and other stomach diseases, according to scientific studies. (2)When probiotic bacteria colonize our mouth, we will very dramatically lower our risk of developing gum disease, bleeding gums, tartar (calculus), and dental cavities in addition to having a constant breeding ground of probiotic bacteria to supply our lower digestive tract:
    http://www.prohealth.com/library/showArticle.cfm?libid=13030&site=research
    http://www.cpmedical.net/articles/lactobacillus-gg-supports-gastric-health

    1. Most people in the USA do not have an adequate supply of probiotics in their intestines, mostly due to the chlorine in the water, stress, and antibiotics in the meat they eat. It would be wise to take probiotics supplements (100 billion/day), or consume sauerkraut if you can stand the taste (yuck), or drink Kefir Water, not the store bought, but home made contains 40-50 strains of probiotics at around 500 billion in a 1/4 cup.

  4. I was wondering if the PREbiotic condition of the vegan “gut” or digestive track isn’t more productive than the PRObiotic effects of eating yogurt or taking pills? It would seem that it might be easier for nutrients (esp. vitamins in food) to be assimilated by the body, thereby having a greater effect on inflammation and chronic diseases. What does everyone think?

  5. If taking Ceylon cinnamon AND taking probiotic almond-milk yoghurt in the diet, how far apart should they be taken given that cinnamon has antibiotic properties?

  6. When we went to purchase probiotics the health store told us you have to eat lettuce for breakfast lunch and dinner. Is this true?

  7. Other websites say taking probiotics after a meal places them in an increased acidic environment, and that is bad. You say that’s not true. There is so much conflicting medicine on the web, seems doctors are always right and wrong when they tell anybody what to do.

  8. Any thoughts on the use of probiotics to address the following situation? I have a bug infestation in my home—minuscule black dots on bed, rugs, tile floors. No ID so far, but they’re not bed bugs. A puzzling symptom is that they’re in my sputum. I’ve been told that this is unheard of — no one ever spits out bugs! Would love to hear from someone with relevant first-hand knowledge. Thanks.

    1. Hi Simon: Unfortunately, I don’t think a probiotic is going to solve this problem for you. I would recommend seeing your doctor. It would probably be helpful to bring a sputum sample with you to your appointment. I would also advise that you call a pest control company so they can assess your home ASAP.

  9. I think I am having an allergic reaction to the pill casing of my probiotic. What do you recommend? Sprinkle it on food or mix in a beverage?

  10. Hi Andi,

    I am a volunteer for Dr. Greger. Thank you for your question.

    Considering Dr. Greger’s advice to take the supplement with (or close to) a meal, I would sprinkle the probiotic on food. As always though, a majority of your gut bacteria will be through the food you eat. That’s why it’s so important that we eat the right kinds of food, regardless of whether we take a probiotic or not.

    Hope this helps answer your question!

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