How To Use Probiotics Properly

Probiotics are commonly prescribed and safe supplements, but they are overused and at times misunderstood by patients and practitioners. I will share some important things I’ve learned about probiotics from my clinical practice and research, so you can be better informed about 1) whether you need to take them, 2) selecting the right product, and 3) how to take them.

Essential Probiotic Principles

stick with multistrain

Research on probiotics is really just getting started. As things stand, most studies have been done on multistrain products, meaning multiple species in one capsule. These are usually different species of Bifidobacteria and Lactobacillus, which are bugs that tend to be low in IBS patients. There is very little research to support the use of single strain probiotics for intestinal conditions in humans.

dose matters

In my practice, I almost always use doses of at least 50 billion CFU’s (colony forming units). Studies have shown that the benefits of multistrain probiotics are often greater when the dose is higher. When you swallow a probiotic capsule, many of the live bugs can get destroyed by stomach acid, bile, and digestive enzymes. The higher the dose, the more good bugs will reach further into your digestive tract. For example, if dealing with colon issues, the dose should be at least 100 billion. Small intestine issues like IBS can benefit from a 50 billion CFU dose. Always check with your health care provider to ensure this is the right approach for you!

take with food

This is one of the most commonly misunderstood principles! Acidity is actually greater when the stomach is empty. While some bugs are more resistant to stomach acid, many get wiped out before they reach the intestine. More species will survive in a lower acidity environment, and acidity is lower when you eat something.

if you see benefits, take them consistently

Supplemental probiotic bacteria are not able to stick to your intestinal lining and grow (aka colonization), so their benefits last only while taking them continuously. Most beneficial bugs wash out of your system within 7 days of stopping the probiotic.

When To Use Probiotics

I don’t believe that everyone should supplement with probiotics for general wellness. I tend to use probiotics for intestinal issues, problems with the immune system, and sometimes for mood disorders like anxiety (because of the gut-brain connection).

For gut health and IBS specifically, probiotics act as antimicrobials, meaning they can help kill other invasive and overgrown bacteria in cases of bacterial imbalance (dysbiosis). Certain species like Lactobacillus reuteri and Saccharomyces boulardii are especially good at reducing and preventing bacterial overgrowth in the small intestine. Probiotics, however, are not as strong as herbal antimicrobials when doing a proper gut reset.

Probiotics can also serve as prokinetics to improve intestinal contractions and movement (motility). In IBS, many bad symptoms come from the intestine not being able to contract and clean itself properly, so you get an overgrowth of bad bacteria and too much gas production by those bugs. Probiotics can help the intestine contract better and prevent overgrowth.

Probiotics & SIBO

In most digestive health cases, I prefer to use probiotics without prebiotics in them. The most common ones to look out for are FOS and inulin. These prebiotics are like food for all bacteria, so if you have an overgrowth of bad bugs, FOS/inulin can make bloating and bad stools even worse by feeding the wrong bugs. I frequently see this in my SIBO patients. So when prescribing probiotics, I will use them for their antimicrobial and prokinetic functions without prebiotic ingredients.

Probiotics can be supplemented on the same day (but not at the same time) as herbal antimicrobials to maximize bug killing, but many practitioners (myself included) prefer to give them to patients after their initial antimicrobial treatment so that we don’t introduce additional bacteria to an overloaded system. Both approaches can be beneficial.

What Else Are Probiotics Good For?

Outside of IBS cases, I prescribe very high dose probiotics to help reduce inflammation in autoimmune diseases of the colon, like Crohn’s and ulcerative colitis. Probiotics can positively influence your immune system to be less reactive, so these autoimmune conditions and even allergies can improve while taking them.

The best scientific evidence for using probiotics is for antibiotic associated diarrhea, and I can confirm this with my clinical experience. Antibiotics, while at times necessary, are a shotgun that can obliterate your microbiome. The small intestine is especially sensitive to this attack. During antibiotic use, nasty opportunistic bacteria can take over and dominate your microbiome, for example candida, klebsiella, and clostridium difficile. Luckily probiotics may be a solution for this risk, as they work by actively preventing bad bugs from overtaking your microbiome. So if you’re on antibiotics, it’s a good idea to supplement with a high quality multistrain probiotic.

A Final Word On Probiotics

Probiotics can be a great addition to your digestive, autoimmune, or mood support care plan. Unfortunately, they are way over-prescribed, and incorrectly prescribed! This is why we always recommend working with a Naturopathic Doctor so probiotic treatment is customized to you.

If you want to learn more about how to choose the right probiotic to help support your health, you can book a complimentary consult with me here, or contact the clinic to learn more!

Also - if you’re ready to learn more about how Naturopathic Medicine can support your IBS, you can check out our resource pages here.