Should Probiotics Be Taken Before, During, or After Meals?

Should Probiotics Be Taken Before, During, or After Meals?
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Proper timing of probiotic supplements may improve their survival.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Though foods may be “better carriers for probiotics than supplements,” if one does choose to go with supplements, should they be taken before, during, or after meals? “When it comes to probiotic supplements sold in capsules the commercial literature is often confusing in that sometimes the consumer is instructed to take the probiotics with meals, sometimes before or after meals, and, occasionally on an empty stomach. This has led to serious confusion for the industry and the consumer.” Surprisingly it doesn’t appear as if any studies had ever examined this question—until now.

To be able to measure probiotic concentrations, minute by minute throughout the entire process, they had to build a fake digestive tract—fake stomach; fake intestines—but complete with real saliva and digestive enzymes, acid, bile, etc.

What did they find? Here’s the survival of three different types of probiotics before, during, and after meals; and separately, in oatmeal and milk, milk alone, apple juice, or water.

Conclusion: probiotic “bacterial survival was best when provided within 30 minutes before or simultaneously with a meal or beverage that contained some fat content.”

Please consider volunteering to help out on the site.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Though foods may be “better carriers for probiotics than supplements,” if one does choose to go with supplements, should they be taken before, during, or after meals? “When it comes to probiotic supplements sold in capsules the commercial literature is often confusing in that sometimes the consumer is instructed to take the probiotics with meals, sometimes before or after meals, and, occasionally on an empty stomach. This has led to serious confusion for the industry and the consumer.” Surprisingly it doesn’t appear as if any studies had ever examined this question—until now.

To be able to measure probiotic concentrations, minute by minute throughout the entire process, they had to build a fake digestive tract—fake stomach; fake intestines—but complete with real saliva and digestive enzymes, acid, bile, etc.

What did they find? Here’s the survival of three different types of probiotics before, during, and after meals; and separately, in oatmeal and milk, milk alone, apple juice, or water.

Conclusion: probiotic “bacterial survival was best when provided within 30 minutes before or simultaneously with a meal or beverage that contained some fat content.”

Please consider volunteering to help out on the site.

Image thanks to Davina Diaries

Doctor's Note

What dose should we take, and under what circumstances? See my first video in this series: Preventing & Treating Diarrhea with Probiotics. Then, I compared probiotics to prebiotics in Preventing the Common Cold with Probiotics? The series ends with Gut Feelings: Probiotics & Mental Health.

Update: In 2017, I released a new video on probiotics. See: Culture Shock – Questioning the Efficacy and Safety of Probiotics

I was surprised to find so few actual data on this topic, but that is par for the course for much advice about dietary supplements. See, for example, this series:

Vitamin D supplements should also probably be taken with meals for maximum efficacy (see Take Vitamin D Supplements with Meals).

For further context, check out my associated blog posts: Probiotics & DiarrheaProbiotics During Cold Season?How Should I Take Probiotics?; and How Probiotics Affect Mental Health.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

64 responses to “Should Probiotics Be Taken Before, During, or After Meals?

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    1. Hyperactivity can be a result of the variety of cells trying to compensate for intestinal destruction while fighting pathogens in the gut, so I personally believe that pre and probiotics, but mainly food culture, can assist in helping the rebuilding, maintenance and battle-for-good in your gut. Also, just to note, prebiotics are usually fibers (or whatever non digestible substance) that promotes growth, well being and activity for gut flora.




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    1. Eating a probiotic yogurt may help, just be wary of the sugar content. Shoot for non-sweetened varieties and consume it with a whole fruit. Aside from probiotic yogurts though, consuming more fermented/cultured foods (and probiotic supplements if you desire, I don’t rely on them) will aid in the defense line and repair crew of your gut.




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      1. Skip the dairy and go directly to whole fruits and vegis, grains, starches. The dairy causes mucus which adds to the gut trying to rid the body of them. The fiberous natural foods will heal the gut, sweep it clean, and give the little gut bacteria something to grow on.




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  1. Re: probiotics for diarrhea

    Seven years ago, I had a serious case (all 10 biopsies came back positive) of microscopic colitis. I had been sick — and getting progressively worse — for several months, had become severely lactose intolerant, and had lost 15 pounds. Other options eliminated (liver nearly destroyed, with talk of transplant possibly necessary), my gastroenterologist said the only remaining option was corticosteroids. Having spent a lifetime keeping my weight under control, I refused, saying I’d rather die, and, frankly, expected to do just that.

    My husband put me on an “all white food diet” (nothing to stress the colon) that he found on the Internet and bought the most potent probiotics he could find. With his treatment, I was completely cured in about six weeks.

    I am a firm believer of probiotics… And VERY glad I refused the steroids.




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    1. EdieP you should review our probiotic products. http://www.myxcellentchoice.com/riverwoods23. Our formulator John R Taylor Naturopath and author of The Wonder of Probiotics collaborated with world renowned probiotic expert Dr. Khem Shahani. Dr. Khem Shahani was a pioneer in the field of probiotics and is widely regarded as one of the world’s leading probiotic authorities on their role in digestive health and immune response.




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  2. I have a question…are probiotics recommended as a daily supplement or just as a “treatment” for a period of time after taking antibiotics (or for some other digestive issue)? If the latter, for how long should they be taken?




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    1. From my experience, if you needed them once, better keep taking them. They’re expensive, so I’ve tried dropping them after all seems well, but every time I do, it isn’t long before problems begin to resurface.




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    2. You only need to take them a few times before the bacteria in you gut will self colonize. Adding more probiotics after this point is pointless. Typically diet determines which strain will proliferate.




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      1. There are very few, if any, probiotic strains that actually colonize (they are foreign organisms to the body after all), most do not last. So yes, you need to take them on a regular basis.




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        1. Gut bacteria feed on soluble fiber and the colony grows. Plant food is known as a prebiotic for this reason. The gut is an ecosystem of its own, the flora is not threatened by the bodies immune system. There is no evidence to conclude that one must continue taking probiotics after the gut is colonized. Yes they are foreign, but they are not circulating throughout the blood stream.




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    3. Just went to a seminar where the Phd recommended 2 weeks on and 2 weeks off. If the bacteria get too used to being supplemented, they could get lazy and not reproduce. If you give them a little shock every 2 weeks, they remain strong. I am in the midst of trying it.




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  3. i particularly like when you make written comments on the audio as I often do not have time to listen to the complete audio version. I think I am a visual learner, rather than auditory. Mthx, love you info.




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  4. Does cooking kill the probiotics in a food? Does Tempeh contain probiotics? Can Tempeh be eaten straight from the package without cooking?




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    1. The answers are : yes, no and no. Tempeh does not contain any known probiotic. Unless specifically added no naturally fermented product can contain probiotics. These have to be added specifically. As tempeh is a fungus, it is wiser to fry or cook it before eating.




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  5. A slight tangent, but as living with pets has been associated with reduced infections and allergies in children (http://nutritionfacts.org/video/are-cats-or-dogs-more-protective-for-childrens-health/), I thought this recent paper examining the microbiota of families with dogs was worth sharing. Dogs are bringing a bit of nature back into our sanitary, but less biotically diverse households, and sharing it with us:

    Song, Se Jin, et al. “Cohabiting family members share microbiota with one another and with their dogs.” eLife 2 (2013). http://elife.elifesciences.org/content/2/e00458

    Dogs: the probiotic for your household.




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    1. Darryl: The study you point out reminds me of a study that I saw summarized on TV not too long ago. They looked at the bacteria on the skins of a team of roller derby (? I think it was that – where they race around a tract in teams on roller skates) women. They looked before and after a game. After the game, the bacteria had changed significantly. The team members were sharing a lot more bacteria with each other. Or something like that.

      My (Great Dane) dog lies on my lap on the couch and licks my face in the morning to get me up. I imagine I’m just swimming in his microbiota (a new word for me). But as long as it’s mutual, I guess I have no reason to be grossed out.

      Thanks for bringing this up.




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  6. I love it when a doctor tells me I have an excuse to eat, “a meal or beverage that contained some fat content.” ;-)

    Alas and alack, I don’t think I have a reason to take a probiotic supplement at this time. If I do find myself with the need in the future, I’ll be reviewing this video.

    Interestingly enough, it was my dog who recently needed a probiotic supplement after being on antibiotics. He ate a special probiotic powder made just for dogs for a couple of weeks in addition to his regular meals. I think it’s kind of funny that my dog got probiotics in light of Darryl’s comment about “Dogs: the probiotic for your household.” (nice comment Darryl!) Sort of a circular thing at my house.

    Just one more reason to love dogs!




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    1. Thea No need for supplements, just try some live wild cultured whole foods like cashew or other nondairy cheese, sauerkraut, kimchi, natto, miso, kombucha, mustard, nondairy yogurt, kefir water etc.




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      1. I am a big fan of cashew cheese made of home-made rejuvalac. I’m just super-conscious of how calorie-dense it is. That’s a big concern for me. And of course, I couldn’t feed that to my dog…

        Also, I have no idea what/which probiotics are actually in the home-made rejuvalac – or if it makes a difference how old the stuff is. One theory I have is that the bad bacteria multiply and take over any good bacteria the longer the rejuvalac has been sitting in my fridge. My theory is that the anerobics are bad and anerobics can take over the longer the liquid is in an air tight container. I don’t have any evidence for that.

        Just some thoughts. I eat the cashew cheese for fun/taste, not for need. If I truly needed probiotics for a medical reason, I wouldn’t personally rely on any of those whole foods you listed. I would want to take something that is controlled with the correct/needed bacteria. If you have a link to a site showing specific analysis of the probiotics in the foods you mention, I would be interested in seeing that. I’m cuirous to know what was found and how much variation there is from product to product and batch to batch.

        Thanks for your thoughts.




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        1. I had seen something like that in my google scholar alerts but can’t find it now, I’ll be sure to post it here when it comes up again.
          BTW there are no bad bactria that grow on cultured food, except perhaps mold on the top you can just scrape off – wisteria, e coli, etc are all animal based and are only found on plants that have been comtaminated, i.e. someone pooped on it or put sewage sludge on it.




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  7. Dr. Greger, I’m wondering if you could make a recommendation as to which brand or which bacteria I’m supposed to look for? (I recently had to take a round of antibiotics for a UTI.) There is a dizzying amount of products on the market, and I’m not sure what to look for. Do you have a favorite brand?




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    1. Align is a good product and easy to find. It is packaged so that it does not need to be refrigerated, which makes it good for traveling or bringing to the office to take mid-day, if you prefer.




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  8. Studies have shown the best time to take a probiotic is on an empty stomach before eating, preferably in the morning. But, if you’re not feeling better in a week, you may want to double the dose, so you’ll be taking it twice a day. This link (http://www.endomune.com/learn/suggested-uses-side-effects) has some good info about side effects.

    I work with EndoMune and I’d be happy to help answer any other questions you may have.




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  9. I have several problems like dandruff, a yeast body odor, and my flatulents really stink. Any ideas? I’m vegan and eat very little processed food. It might be because I have low levels of good bacteria in my gut.




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  10. Thank you for these videos that answer questions I have a hard time finding answers to!!! If you get any info on brands of probiotics that would b nice!




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  11. I’ve read about a probiotic called just thrive probiotic that claims 100% survivability because its in spore form. Not sure what that means or how true it is. Does anyone know anything about spore probiotics?




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  12. Joseph, I recall that Dr Greger said in an earlier video words to the effect that studies show introducing a high load of bacteria to the body (such as in some food cultures) can release a wave of endotoxins which cause inflammation throughout the body – and he stopped eating them because of this. Is he still of the same mind about this?




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    1. Dr. Greger is very good at updating his videos if something is misrepresented, so you can assume his content is accurate. If it’s not and you see a goof he’d surely like to know about it! To try and help answer your question I think the bacteria Dr. Greger mentioned is very different from probiotics if that is what you are referring to? Here is his video that discuss bacterial endotoxins in food. Let me know if this helps and thanks so much for your patience.

      Sincerely,
      Joseph




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      1. I was referring to fermented vegetables. Previously, in response to someone’s question in the comments section Dr Greger said he stopped eating Kim Chi which he eat regularly before the below and another study which I can’t find the link to, showed that even fermented vegetables introduce a high load of bacteria to the body and it can release a wave of endotoxins which cause inflammation throughout the body. (http://nutritionfacts.org/video/dead-meat-bacteria-endotoxemia/) – would you ask Dr Greger whether he still avoids fermented vegetables such as those one can purchase in glass jars in health food outlets? I understand that its not necessary to eat fermented vegetables to get a healthy microbiome if one is eating well but I would still like to know whether eating fermented vegetables is something to avoid. Many thanks!




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  13. I make my own water kefir and drink about 8 oz a day. I was looking to see what the good doctor thought of this as a source for healthy gut flora. I see nothing on this site about kefir and would love to know if I’m on the right track. Is it necessary daily? I eat mostly plant based whole foods…




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  14. Hi, I am taking a capsule of probiotic at night and drinking a fiber sweep in the morning. I am wondering if the fiber is sweeping out all the probiotics as well. Should I be concern to be taking this the wrong way. Thanks in Advance.




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  15. I have a question slightly off the topic but related. I have severe eczema im plant based so are my kids. mine has got a lot better over the years, my little boy flares up but not as severe as mine used to. ive been reading about probiotics long term for eczema in kids. My kids and me eat loads of prebiotic foods, loads of oats bananas etc, but not many fermented foods, maybe a soy yog a day. ive been trying (and forgive me sometime i forget) to each day give him either a vegan kids probiotic supplement, or when ive run out i will crack open one of my capsules and sprinkle it on his soy yog.
    can you overdo probiotic tablets? as is dosage and how many billion bacteria in a supplement need to be adjusted for kids? im trying to work out if kids pro bios are not needed and we could all simply have the same thing? :)
    would love advice from everyone on this :)




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  16. I have a question slightly off the topic but related. I have severe eczema im plant based so are my kids. mine has got a lot better over the years, my little boy flares up but not as severe as mine used to. ive been reading about probiotics long term for eczema in kids. they eat loads of prebiotic foods, loads of oats bananas etc, but not many fermented foods, maybe a soy yog a day. ive been trying (and forgive me sometime i forget) to each day give him either a vegan kids probiotic supplement, or i crack open one of my capsules and sprinkle it on his soy yog.
    can you overdo probiotoic tablets? as is dosage and how many billion bacteria need to be adjusted for kids? im trying to work out if kids pro bios are not needed and we could all simply have the same thing? :)




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  17. In recent videos, you talk about creating a vegan environment in your intestines that reduce the bacteria that are meat favorable to ones more favorable to plant based diets. Does taking probiotics in pill form defeat this purpose?




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    1. The probiotic bacteria thrive on the prebiotic environment of a high fiber diet, which is primarily of vegan origin. I would think eating vegan would enhance the ability of the probiotics to do their good work.




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  18. Does anyone know anything about SIBO (small intestine bacterial overgrowth?) What to do for it, that is not Toxic, like antibiotics. Also, I am a metastatic breast cancer patient, so I try to eat only plant-based, mostly legumes and cruciferous veggies and the like, and those are the very things that seemingly contribute to the whole bacterial problem. I don’t know how to effectively treat the SIBO AND address my cancer concerns. Any help would be greatly appreciated. Thank you.




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  19. Would a dash of kefir in the morning muesli be of any benefit? My thinking is that kefir has twelve different bacteria which might help maintain intestinal diversity. Yes, I know it’s dairy, but the amount added to my cereal is tiny.




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  20. Hi Guardian333,

    I am a volunteer for Dr. Greger. Thanks for your question. A dash of kefir, since you are referring to a small amount, likely will have little impact overall on your health–good or bad. In fact, if you eat almost any food in very small quantities, it is very unlikely that it will hurt you, just as small amounts of healthy foods are not very likely to help you. Because eating plant foods as a probiotic is just as effective, if not more so, than using prebiotics, the use of kefir to me seems unnecessary. However, if you do feel the need to use a prebiotic, perhaps a prebiotic supplement would be better, since it will not contain the lactose, cholesterol, or animal protein found in kefir. I hope this helps answer your question!




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  21. This video contrasts Dr. Klaper’s advice to take the probiotic 1 hour before eating or 2 hours before bed. Both times on an empty stomach to avoid the stomach acid assault on the probiotic. This is confusing.




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  22. Hello Dr. Greger

    How much probiotics?

    Also, have you come across the books by Anthony William, “Medical Medium” and the next will be on the market in October, called “Thyroid Healing”.




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  23. Hey Dolly, thanks for writing! A WFPB diet nicely encourages the growth of beneficial bacteria in the gut; probiotic supplements shouldn’t be needed on a regular basis if you’re eating this way. They can be used effectively to relieve symptoms when dealing with an intestinal infection or if dealing with side-effects of antibiotic treatment, for short periods of time (1-3 weeks).




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