The Best Probiotic Supplement
It’s a jungle in there
Probiotics are all the rage, but there's not a ton of science on them yet. To find the best strains — in the best combinations — we talked with a neurologist and New York Times bestselling author, a board-certified doctor of natural medicine, and an internationally recognized probiotic microbiologist. Our findings revealed the best ones have clinical evidence of their efficacy (and zero junk ingredients).
The stats on this probiotic are pretty astounding: 50 billion CFUs of 33 bacteria strains, including the core five recommended for general health. At $0.98 per pill, it's more expensive than the average per-serving cost of $0.69.
MegaFlora also has the core five bacteria for general health — it scored second place because it has a lower number of strains (14) and a lower CFU count (20 billion), but it also has a lower price tag to match (only $0.48 per serving).
Custom Probiotics 11 Strain Probiotic Powder($115)
Best for Antibiotic Recovery
Renew Life Ultimate Flora Extra Care 30 Billion($24)
Best Immune Booster / Best for Anxiety and Seasonal Allergies
Best for IBS, IBD, and Acute Infectious Diarrhea
Innovix Labs Multi-Strain Probiotic($24)
Best for Lowering Cholesterol
Best for Weight Loss
Bio-Kult Advanced Probiotic Multi-Strain Capsules($37)
Best for Lactose Intolerance
Garden of Life RAW Probiotics Ultimate Care($34)
Best for Women’s Health
You’re not living alone in your body. In the humble human gut, there are hundreds of trillions of bacterial occupants, and they’re not just living there — they’re working for you. In addition to their more infamous duties of keeping the GI trains running on time, that gut flora makes up 70–80 percent of the human immune system and plays a central role in regulating inflammation in the body. The best probiotics, like our top pick, Garden of Life RAW Probiotics Colon Care, have bacteria strains proven to be clinically effective and contain no junk ingredients. Even better, they’re guaranteed to have viable doses; after all, we want those guys alive, not dead.
A small but growing body of research on our gut tenants suggests that hacking your microbiome can not only improve the digestive process, but also contribute to a laundry list of ancillary health benefits. We’re talking weight loss, lower cholesterol, decreased anxiety, improved immune function, fewer seasonal allergy symptoms, and relief from a host of gastrointestinal malities, from irritable bowel syndrome to travelers diarrhea. We’re in! But we’re also skeptical.
Whenever we hear about a product with such a prolific and dramatic list of benefits, especially ones that don’t seem straightforwardly linked, we’re a little inquisitive (and aren’t surprised that you are too). So, we started by finding out exactly how and why probiotics work. We interviewed industry experts and analyzed the findings of 169 clinical studies and the results of a third-party lab test to identify the right strains and their minimum effective dosages.
How We Found the Best Probiotic Supplement
We started our search with the most popular products from major online retailers like Amazon, Drugstore.com, and GNC, and a handful of health food stores, like Whole Foods and local organic co-ops. We also included product recommendations from nutrition specialists, bloggers, and third-party lab tests. That initial list had 277 top-rated probiotic supplements.
From there, we cut any probiotic supplement that only contained one strain of bacteria.
Though it may seem like a targeted assault would be the way to go, research suggests that probiotics actually work better as a team than on their own. Even pairs can be more effective than individuals, as is the case with Lactobacillus Acidophilus and Bifidobacterium Bifidum BB-12. When combined, this duo-force has been shown to have a positive effect against an extremely nasty and antibiotic-resistant GI infection.
Selecting a multi-strain probiotic is also consistent with the theory that if you cram your gut with enough good bacteria, it will outcompete any bad bacteria for the same space and resources — in the same way introducing a predator into an environment can help manage another species. The more diversified that good bacteria is, the harder it is for the baddies to gain a foothold.
21st Century Acidophilus Probiotic Blen, High Potency, 21st Century Advanced Probiotic Capsules, Align Digestive Health Probiotic Supplement, BioGaia ProTectis Drops with Vitamin D3, Cardioviva Natural Health Probiotic, Country Life Acidophilus, Culturelle – Probiotic All Natural Dairy & Gluten Free, Custom Probiotics B. Longum Powder, Custom Probiotics L. Bulgaricus, Custom Probiotics L. Casei, Custom Probiotics L. Plantarum Powder, Custom Probiotics L. Rhamnosus Powder, Custom Probiotics L. Salivarius, Custom Probiotics S. Thermophilus, Finest Nutrition – Probiotic, Softgels, Florastor – Daily Probiotic Supplement, 250mg, Garden of Life Dr. Formulated Organic Digest+, Garden of Life RAW Digestion RAW Candida Cleanse, Gerber – Rice Cereal Single Grain, DHA & Probiotic, GNC Probiotics Ultra 5 Probiotic Complex with Fiber, GNC SuperFoods 25 Protein Plus Probiotic – Natural Berry Flavor, GoodBelly Plus Shot, Health Labs Rx Advanced Probiotic Extra Strength, Healthy Delights™ Probiotic Greek Yogurt Bites – Greek Yogurt Flavor, Ideal Bowel Support® 299v®, Multi-Strain PROBIOTIC (by InnovixLabs), Natrol – Acidophilus Probiotic, Nature Made – Acidophilus Probiotics, Nature’s Answer® Probiotic Lite™ – Raspberry Lemonade, Nature’s Bounty – Natural Acidophilus Dietary Supplement, Nova Probiotics Ultra Strength Plus, Now Foods Oralbiotic Blis K12, Nutrition Essentials Probiotic, Origin Essentials Probiotic, ProbioSlim™ with Weightloss, Probiotic Dark Chocolate Bites – Dark Chocolate, Purebiotics, Rainbow Light ProbioActive 80mg, Renew Life Advanced Immunity Probiotic Supplement, Renew Life Ultimate Flora Saccharomyces Boulardii 6 Billion, Renew Life Ultimate Flora Sour Gummies, Saccharomyces Boulardii + MOS, Schiff Digestive Advantage – Constipation Formula Capsules, Schiff Digestive Advantage – Daily Probiotic Capsules, Schiff Digestive Advantage – Intensive Bowel Support, Schiff Digestive Advantage – Lactose Defense Formula Capsules, Schiff Digestive Advantage – Probiotic Gummies, Assorted Fruit, Sedona Labs Iflora Multi-Probiotic Formula, Simply Right™ Acidophilus Dietary Supplement, SmartBiotics™ ProbioMune™, Spring Valley Multi-Enzyme Probiotic, Top Secret Nutrition Digestive Enzymes, Twinlab Oral Health Dots Triple Action Tablets, Twinlab Probiotic Endurance Formula Capsules, Up4 Daily Probiotic Billion UAS LifeSciences
We looked for guaranteed viability — that is, bacteria that will still be alive when we swallow it.
Bacteria die out over time. Some supplements list the potency when it was manufactured (before it rode in a truck, sat on the shelf at the grocery store, or hung out in the kitchen cupboard for a few months). There may be dramatically fewer viable bacteria by the time you consume them than when they were first encapsulated, and good bacteria are no good to you dead.
Better probiotic manufacturers will list their potency (in Colony Forming Units, or CFUs) at the time of expiration, ensuring that you get the dosage that you’re paying for. Dr. David Perlmutter, board-certified neurologist, American College of Nutrition Fellow, and author of The New York Times best-sellers Brain Maker and Grain Brain puts it this way: “Avoid products that indicate a specific number of bacteria ‘at the time of manufacture,’ and instead look for products that, like other supplements, have a shelf-life.”
Accuflora – Advanced CD Probiotic Acidophilus, American Health Probiotic Acidophilus, Best Naturals Probiotic, BioGanix BIOPRO 50 Ultimate Probiotic Supplement Billion, DNA Shift Gut and Brain Health Formula, Earth Start, Enzymatic Therapy – Acidophilus Pearls Probiotics, Enzymatic Therapy – Pearls IC Intensive Care Probiotics, Enzymatic Therapy – Probiotic Pearls High Potency Digestive Health, Enzymatic Therapy™ Pearls Elite™, Enzymatic Therapy™ Probiotic Pearls™ Complete, Essential Formulas Dr Ohhiras Probiotics Original, EvoraPlus – Probiotics For Oral Care, Florajen 3 Capsules, Floranex, G-U-M – PerioBalance Daily Dental Probiotic, Fresh Mint, Garden of Life Primal Defense® ULTRA, GNC Multi-Strain Probiotic Complex – 1 Billion CFUs, GNC Multi-Strain Probiotic Complex 10 Billion CFUs, GNC Probiotic Complex Chewable Tablet – Vanilla Berry, GNC Ultra 25 Billion CFUs Probiotic Complex, H2 Probiotics, Healthy Origins -Probiotic 30 Billion CFUs, inner-ēco™ Fresh Coconut Water Probiotic, Just Potent Probiotic Supplement Vegetarian, Labrada: Jamie Eason Signature Series Skinny Bugs Probiotic, LoveBug Probiotics Here’s The Skinny, Natrol: Probiotic High Potency, Nature’s Bounty – Extra Strength Probiotic Acidophilus, Nature’s Bounty – Ultra Strength Probiotic 10, Nexabiotic Advanced Multi-Probiotic, Nova Progressive 55+, Number One Nutrition Probiotic Supplement, Nutrition Now® PB 8® Vegetarian Formula, Nutrition Now® PB8®, Nutrition Now® Pro-Biotics Acidophilus, Omnibiotics Flora Renew, PRO Dental Probiotics Probiotic Including Salivarius, Pro4-50™ D-Lactate Free Multistrain Probiotic, Probacto, Probinox, Puritan’s Pride Rapid Release Probiotic, Rainbow Light Probiolicious Gummies Natural, Renew Life Floramore, Renew Life Ultimate Flora Extra Care Probiotic 200 Billion, Solgar Advanced Multi Billion Dophilus® (Non Dairy), Sportbiotic, Swanson Probiotics Dr. Stephen Langer’s Ultimate 16 Strain, Trubiotics Supplements 30, Udo’s Choice Advanced Adult Probiotic, Usana Probiotic, Vibrant Health Green Vibrance, Vitamin Shoppe Ultimate 10 Probiotic 13 Billion, Vitamin World Probiotic 10, Walgreens – Super Probiotic Digestive Support Capsules
We cut any junk ingredients.
We ditched artificial sweeteners Sucralose and Splenda, as well as the sugar alcohol Xylitol. There’s nothing beneficial about them and they might even be harmful. There’s also no room for titanium dioxide — a whitening agent — in our probiotics. Who cares about the color of the pills or powder? This isn’t a beauty contest.
Bio-K Plus 12.5 Billion, Bio-K Plus 25 Billion, Bio-K Plus 50 Billion, Bio-K Plus Travel Protection Capsules, Equate Probiotic Digestive, System Support 4X Digestive Care, Finest Nutrition – Digestive Probiotic Maximum Care Capsules, GNC Ultra 25 Billion CFUs Probiotic Complex Multi Strain, GNC Ultra 25 Billion CFUs Probiotic Complex Sport, GNC Ultra 25 Billion CFUs Probiotic Complex with Enzymes, GNC Ultra 25 Probiotic Complex with Enzymes, GNC Ultra 75 Probiotic Complex, GNC Ultra Probiotic Complex 100, GNC Ultra Probiotic Complex 25 with Vitamin D-3, GNC Ultra Probiotic Complex 25 With Weight Management Support, GNC Ultra Probiotic Complex 50, Jamieson Laboratories Probiotic Sticks, NOW Foods BerryDophilus Chewables, Renew Life Ultimate Flora Colon Care Probiotic 80 billion, Trunature Digestive Probiotic
We cut probiotics that contained a prebiotic.
Lots of probiotics tout these prebiotics as a symbiotic partner to probiotics (some even call them “synbiotics”). Prebiotics are carbohydrates or sugars that the normal human gut flora has a hard time breaking down — but that probiotics go crazy for. The cluster of simple sugars found in legumes (oligosaccharides) is a good example. Probiotics don’t just love these carbs; they need them to grow their colonies.
So why did we nix them? You need at least five grams of them to make an impact — way more than the one-quarter gram that fits in a probiotic capsule. At these levels, it’s just marketing hype. And if you have a decent diet, you’re probably already eating enough of them anyway. “The reality is that probiotics thrive on the natural sugars and fiber present in plant-based foods like fruits, vegetables, legumes, and grains,” said board-certified Doctor of Natural Medicine Michelle Schoffro Cook. “Eating real food and taking probiotic supplements is a far better way to go than worrying about getting enough prebiotics too.”
- Prebiotic Fiber (acacia)
- Fructo-oligosaccharides (FOS), including inulin*
- Isomalto-oligosaccharides (IMO)
- Galacto-oligosaccharides (GOS)*
- Polydextrose (PDX)
- Xylo-oligosaccharide (XOS)
- Mannan-oligosaccharides (MOS)
- Soybean oligosaccharide (SOS)
- Gluco-oligosaccharide (GlOS)
- Genti-oligosaccharides (GiOS)
- Arabino-xylo-oligosaccharides (AXOS)
- Germinated barley foodstuffs
- Gluconic acid
- Glutamine and hemicellulose rich substrate
- Resistant starch and its derivatives
- Oligosaccharides from melibiose
- Lactoferrin-derived peptide
- Isoflavonic phytoestrogens
Prebiotics are readily available in most plant-based foods. Taking up valuable real estate within a tiny capsule is not well-served when that space could be better used by adding more probiotics. While prebiotics can be helpful for those with appalling diets, they are not necessary for most people. The inclusion of prebiotics in capsules is more marketing hype than valid practice.
To make matters worse, prebiotics can also aggravate certain conditions like Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), and Small Intestine Bacterial Overgrowth (SIBO), for which you might be taking probiotics to treat in the first place.
Bifidus Balance® + FOS, Culturelle – Probiotic Digestive Health Capsules, Dr Natura Flora Protect® Probiotics, Dr. Dave Williams Colon Health, Dr. Dave Williams Probiotic Advantage, Dr. Mercola Complete Probiotics, Flora Biotect, Flora Udo’s Choice Super 8 Hi-Potency Probiotic, Garden of Life Dr. Formulated Fitbiotic™, Garden of Life Dr. Formulated Mood+, Garden of Life Dr. Formulated Once Daily, Garden of Life Dr. Formulated Once Daily Ultra, Garden of Life RAW Gluten-Free Support, GNC GNC Ultra 25 Probiotic Complex, GNC Ultra 100 Billion CFUs Probiotic Complex – Unflavored, GNC Ultra Probiotic Complex 25, GNC Ultra Probiotic Complex 25 Plus Energy, Go Live Flavored Packets, HCP®70, Jarro-Dophilus EPS®, Jarro-Dophilus EPS® Higher Potency, Jarro-Dophilus® + FOS, Jarro-Dophilus® + FOS Powder, Jarro-Dophilus® Allergen-Free, Jarro-Dophilus® Original, Mood PROBIOTIC (by InnovixLabs), Natures Design Probiotic, Naturo Science Probiotics Advanced Probiotic Supplement Guaranteed, Nordic Naturals Probiotic Sport, Nova Probiotics Daily Probiotic Immunity, Nova Probiotics Immune Boost Probiotic, Nova Probiotics Lactose Free Gluten Free Probiotic, Nova Probiotics Nova Probiotics, Nova Probiotics Probiotic Capsules Original, Nova Probiotics Ultra High Potency Vegan Probiotic, Nova Probiotics Ultra Strength Probiotic, Nova Probiotics Vegan Sport Probiotic, Nova Probiotics Vegan Xtreme Care, Nova Probiotics Xtreme Care, NOW Foods Probiotic 10 25 Billion, NOW Foods Probiotic 10 50 Billion, Now Optimal Digestive System, Optimal Health Systems: Flora Plus, Phillips – Colon Health Probiotic Caps, Pinnacle Nutrition Advanced Formula Complete Probiotic, Prescript-assist Broad Spectrum Probiotic Prebiotic Complex, Primadophilus Optima, Primadophilus Optima 100 Billion, Primadophilus Optima 60 Billion, Primadophilus Optima 90 Billion, Primadophilus Reuteri, Primadophilus Reuteri Powder, PRO 15 Advanced Strength Probiotics Technology, PRO 15: #1 Recommended Best Probiotic, Probium Probiotics Multi Blend 12B, Renew Life Ultimate Flora Extra Care Probiotic 50 billion, Renew Life Ultimate Flora Probiotic Fizzy Drink Mix Mixed Berry, Renew Life Ultimate Flora Probiotic Fizzy Drink Mix Raspberry Lemonade, Senior Jarro-Dophilus®, Ultra Jarro-Dophilus, Webber Naturals® Complete Probiotic, Whole Body Research Keybiotics Probiotics
Our Picks for the Best Probiotic Supplement
Best Probiotic for General Health
Garden of Life RAW Probiotics Colon Care Garden of Life's impressive ingredients list more than makes up for its slightly higher-than-average asking price.
Maybe you don’t have a specific pathology or health goal in mind, but you do want to get more probiotics in your diet to bolster the amount of good bacteria floating around your system. Dr. Perlmutter recommends starting at a minimum of eight to 10 different bacterial species, including the core five: L. Plantarum, L. Acidophilus, L. Brevis, B. Lactis, and B. Longum. Both our top picks for general health have this lineup, plus a handful of other beneficial strains.
Runner-Up for General Health
MegaFlora Probiotics It’s got 20 billion active bacteria and 14 strains, including the core five — at about half the cost of Garden of Life RAW.
Garden of Life is one of the most trusted brands in the probiotics market and for good reason: Its strain profiles are of extremely high quality and well-researched. At first we were critical of the “Eastern European RAW Fruit and Veggie Blend” of cherries, peas, and carrots that make up 45mg of the overall ingredients. Would that leave room in the capsule for enough bacterial might? Oh yes. The bacterial contents are pretty astounding: 33 strains, including the core five, at 50 billion CFUs per pill. At $0.98 per serving, this supplement costs a little more than the average $0.69 per serving, but well under some of the more expensive options that can reach upward of $6.
Best for Antibiotic Recovery
Custom Probiotics 11 Strain Probiotic Powder While it may not have the name recognition of others in the industry, Custom Probiotics impressed us with its high quality and potent ingredients list.
Antibiotics wreak havoc on your microbiome by decimating both good and bad bacteria — an effective treatment if you have an infection, but without the gut good guys, you’ll come out the other side of any course of antibiotics with a weaker immune system. Side effects aren’t so pretty either: vomiting, diarrhea, and even susceptibility to a C. Diff infection.
It’s tempting to think of probiotics as re-populating your post-apocalyptic gut with good bacteria after the fallout from antibiotics. Not quite. Most of the bacteria native to the human microbiome aren’t in probiotics. To truly “repopulate” your system, you’d need a human fecal transplant (exactly what it sounds like) and you’re not going to find that in a jar.
However, certain probiotic strains can help with antibiotic-associated symptoms in other ways. Taking relatively high doses of these probiotic strains before, during, and after antibiotic treatment can help your microbiome get back on its feet: B. Lactis, B. Infantis, L. Acidophilus, L. Casei, L. Bulgaricus, L. Paracasei, L. Rhamnosus GG, S. Boulardii.
Runner-Up for Antibiotic Recovery
Garden of Life RAW Probiotics 5-Day Max Care The 5-Day Max Care is formulated with gut flora replenishment in mind: 34 probiotic strains and an enormous 400 billion CFUs. At $5.99 per serving, though, it is the most expensive supplement we looked at, especially since the five-day program may not even cover a full antibiotic treatment, let alone the ideal pre and post treatments.
Renew Life Ultimate Flora Extra Care 30 Billion Renew Life’s Ultimate Flora Extra Care hits all the right notes when it comes to price, CFU count, and ingredients.
In addition to the prophylactic effect of stocking your gut with good bacteria, there are some probiotic strains that can actually improve immune function, and some have even shown promise in treating symptoms of certain autoimmune disorders. L. Planatarum and L. Paracasei in particular can improve immune function with as little as 500 million CFUs daily, and a combination of L. Acidophilus and B. Lactis at 2.5 billion CFUs twice daily has been shown to improve upper respiratory infections.
Though it’s not explicitly formulated for immune health, Renew Life’s Ultimate Flora Extra Care contains all of the requisite strains for immune boosting, plus an additional two Bifidobacterium and four Lactobacillus strains. We liked this supplement for its respectable CFU count (30 billion, a solid choice for an everyday supplement), right-around-average price point, and an ingredients list blessedly devoid of fillers, harmful ingredients, and common allergens.
- Innovix Labs Multi-Strain Probiotic ($24)
- Renew Life Ultimate Flora Adult 50 Plus Probiotic, 30 Billion ($25)
- Renew Life Ultimate Flora Everyday Probiotic, 15 Billion ($20)
- Renew Life Ultimate Flora Extra Care Probiotic, 30 Billion ($22)
- Renew Life Ultimate Flora Extra Care Probiotic, 50 Billion ($36)
- Renew Life Ultimate Flora Men’s Complete Probiotic ($46)
- Orthobiotic ($64)
Best Probiotic for IBS/IBD/Acute Infectious Diarrhea
VSL#3 Those with IBS, IBD, or Acute Infectious Diarrhea should take a look at VSL#3 or its more potent, prescription-based version, VSL#3D.
There has been a lot of research on treating IBS and IBD symptoms with probiotics, much more than on most other pathologies. VSL#3’s prescription formulation (VSL#3D) has been at the center of several pivotal studies on the subject and has been proven to be clinically effective — extremely rare for a probiotic supplement. The over-the-counter option has less than half as many CFUs, but is the exact same formula strain for strain. You can buy 225 billion CFUs daily without a doctor’s signature for $1.70 a serving; with one you can get 450–900 billion.
Other Probiotic Supplements to Consider
The research on probiotics is still in its infancy, but it seems that there’s a lot more that probiotics can do than improve “time to discharge” and other trademarks of the lower intestines.
Through the course of our research, we came across a number of studies that indicated some lesser-known benefits of taking probiotic supplements, like decreased anxiety. We put together our top picks based on which strains had solid evidence backing up a connection. Not all of these supplements necessarily contain every relevant strain, but they checked off the most boxes where it counts.
Anxiety and Allergies
Relevant strains: L. Casei, L. Rhamnosus, Paracasei
Our Pick: Renew Life Ultimate Flora Extra Care Probiotic, 30 Billion ($25)
Relevant strains: B. Brevis, B. Lactis, L. Acidophilus, L. Gasseri, L. Rhamnosus GG
Our Pick: MegaFlora ($44)
Relevant strains: L. Bulgaricus, S. Thermophilus
Our Pick: Bio Kult Advanced Probiotic Multi Strain Capsules ($37)
Relevant strains: B. Lactis, E. Faecium, L. Acidophilus, L. Curvatus, L. Fermentum, L. Plantarum, L. Reuteri
Our Pick: Innovix Labs Multistrain Probiotic ($24)
Relevant strains: Bacillus Coagulans, L. Fermentum, L. Rhamnosus GG
Our Pick: Garden of Life RAW Probiotics Ultimate Care ($34)
Curious about the other 16 probiotics that passed all our cuts? These guys all have guaranteed potency on multiple bacterial strains — plus no junk or marketing ploys.
Bio-K Plus Soy Drink, Custom Probiotics Adult Formula CP-1 Capsules, Custom Probiotics D-Lactate Free Probiotic Powder, Custom Probiotics Five Strain Bifidobacteria, Custom Probiotics Four Strain Lactobacilli, Custom Probiotics Six Strain Probiotic Powder, GNC Ultra 25 Probiotic Complex Plus Immune, HCP®150, HCP®30, Hyperbiotics Daily Immune & Wellness Formula, Metagenics UltraFlora Balance, Naturenetics Flora Pro-Health, Organic3 GutPro, Renew Life, Ultimate Flora Adult 50 Plus Probiotic 25 billion, Renew Life Ultimate Flora Extra Care Probiotic 100 billion, Ultimate Probiotic Supplement Vegetable Capsules
Did You Know?
There is still a surprisingly small amount of research on probiotics.
Although the idea of beneficial bacteria has been around since the late 1800s, and probiotic supplements have been around since the 1930s, there haven’t been many human clinical trials.
We do know that probiotics produce enzymes that help break down chemicals that the normal human gut has a hard time with, such as the oligosaccharides in legumes. That digestive assistance results in less gastrointestinal distress and better absorption of nutrients.
Probiotics also elicit an immune response in the intestines that can help your body deal with certain harmful pathogens and other GI problems. There is actually a mechanism we learned about called cross-talk where, through chemical signals, the bacteria communicate with your body and your body communicates back.
What you read on the probiotics label is part truth, part hype, and part marketing.
As internationally recognized probiotic microbiologist Dr. Mary Ellen Sanders told us, “There’s often a gap between the hype and the science; the hypothesis versus what’s been demonstrated. People like to tell stories: My probiotic will survive stomach acid and others won’t. Instead look at the clinical benefit.”
Unlike the clinical studies, the bottles don’t have to tell the whole truth. “Dietary supplements are marketed for the general population. They are not marketed for at-risk or patient populations, and companies are not obligated to establish safety for these populations,” Dr. Sanders said.
This is because probiotics are classified as Dietary Supplements by the FDA, meaning that manufacturers “are not required by FDA to undergo rigorous premarketing evaluations for efficacy or safety.” In fact, every bottle of probiotics on the market invariably has this fun little disclaimer printed on it:
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
This is caveat emptor (“let the buyer beware”) times a thousand. The burden is entirely on you to take the label’s claims that it’ll “balance your gut bacteria” or “boost your immunity” with a grain of salt, and to talk with your doctor before you start popping capsules.
Probiotics are basically in hibernation.
Relatively few probiotic supplements contain what you might consider “active” bacteria. They are usually dehydrated (through freeze-drying, spray drying, microencapsulation, etc.), which causes the bacteria to go into hibernation until they’re reconstituted in the body. This process makes them shelf stable, though we encountered a lot of conflicting opinions about whether or not cold storage really makes a difference. Some probiotic supplements require refrigeration to ensure maximum potency, and even probiotics that don’t necessarily require cold storage still typically recommend it to slow down cell death and prolong shelf life. This has led to a widespread belief that all probiotics must be refrigerated, and that any brand that claims to be stable at room temperature can’t possibly support viable bacteria.
To get to the bottom of this, we took two probiotic supplements from our top contenders list that didn’t require refrigeration and used them as starter cultures for yogurt. We made a timelapse of the process.
Boom. Those yellow-ish blobs are growing cultures, proving our shelf-stable probiotics from Bio-Kult and Renew Life passed. If you’re ever in doubt of the efficacy of your supplements, it’s an easy test: Just dump one serving in a quarter cup of milk or soy milk, and let them do their thing overnight at room temperature. If your milk turns lumpy or starts to firm up like yogurt, congratulations! You have real live probiotic bacteria. If you’re left with plain milk, consider calling the company to cash in on its viability claims.
You don’t need an enteric coating.
The human digestive system is a pretty inhospitable place for most organisms, and probiotic bacteria are only useful when they make it through the high-acid environment of the stomach. Though most probiotic strains are acid-resistant, many companies use enteric coatings, which protect the probiotics until they’re past the pylorus — the trap door in the bottom of your stomach.
Seems pretty smart, until you start looking at what actually goes into making an enteric coating. In addition to being expensive, the coating process involves a lot of heat, which can compromise bacterial viability. Even more troubling, many enteric coatings contain things like shellac, vinyl acetate, and phthalates (though there are some enteric materials that aren’t sketchy like alginate and hypromellose). There is enough substantial clinical evidence to suggest that probiotics survive, thrive, and get results even without enteric coatings.
The Bottom Line
The science is still young, but we know a few things: Probiotics work better in a pack; prebiotics are just a marketing ploy; and shelf life matters most. Look for multi-strain products and check for a “viability guarantee” through the expiration date to make sure your probiotics will be in full force when you take them.
Best for General Health
Garden of Life RAW Probiotics Colon Care Impressive ingredients from one of the most trusted brands.
Start small. Generally, it’s best to start out with a lower CFU count and ramp up as needed. Starting out with the high-proof stuff can cause unpleasant physical side effects, like cramps and bloating, as well as monetary ones — higher potency supplements are almost universally more expensive. Of course, follow your doctor’s guidance. The verdict on ideal colony count is still out .
Take your probiotic with a meal. This raises the pH in your stomach, which means more bacteria will make it through to your gut, including the few non-acid-resistant strains like S. Thermophilus. And take them with plenty of water; that will further dilute the acidity of gastric juices.
Get your prebiotics in. There are tons of the simple carbs probiotics love in whole fruits and vegetables, including onions, garlic, bananas, asparagus, unpasteurized apple cider vinegar, and artichokes. If you’re worried you might not be getting between five to 20 grams per day, consider taking a prebiotic supplement, usually a powder or drink mix. (Dr. Perlmutter recommends acacia gum.)
Keep up your probiotic routine. Probiotics stick around for a while, though for how long isn’t precisely clear. You have to keep taking them to continue to reap the benefits.