With roughly 50 million of us suffering with GI disorders like irritable bowel syndrome, digestive issues are on the rise. We are learning that diverse levels of gut flora–the ecosystem of bacteria and microbes in our gut– are critical for immune health, weight maintenance, and even mood regulation. Probiotic supplements offer an easy way to supplement your own gut bacteria levels. But do they work? And should YOU take probiotics?

Let me break it down for you: There’s no one size fits all probiotic for everyone, and you shouldn’t continue taking the same one indefinitely.

One of the most common questions I get is, “which supplements should I be taking?” The answer is, unless you have a deficiency, imbalance, or you’re under stress, you shouldn’t need to take handfuls of supplements. Sure, a multi helps fill in the nutritional gaps, and fish oil is an excellent way to reduce inflammation. But when it comes to probiotics, it’s not as easy as grabbing something off the shelf.

Your Gut Flora: The Microbes in Your Digestive Tract

Your gut is home to an unfathomable trillions of microbes (bacteria, viruses, fungi), mostly bacteria, both “good” and “bad.” This is your gut microbiome. Some microbes are commensal, meaning they start out good but can go rogue and turn against you, becoming pathogenic.

Our gut bacteria outnumber our body cells by about 2 to 1, which is pretty remarkable. That means that in order to positively affect the health of your body, start with your gut! (there’s a reason for the popular saying “all disease begins in the gut.“) The majority of our immune system resides in the gastrointestinal tract (GI tract), and the health of our gut also directly impacts our brain health and mood. So, we gotta keep those bacteria happy and plentiful.

The Friendly Neighborhood in Your Gut

We all have the good guys, beneficial probiotic bacteria (flora), and the bad guys, pathogenic bacteria. That’s good– the bad guys challenge the good guys to work harder. Then there are some easily swayed guys–the commensal bacteria–that can be either good or bad, depending on the environment in the gut. They’re call opportunistic because if given the opportunity (overuse of antibiotics, poor diet, birth control pills), they’ll overtake the good guys.

Think of your gut as a neighborhood. There are nicely maintained houses and cops that keep the bad guys and vandals out (good bacteria). But if the cops get lazy or disappear due to poor conditions, the bad guys move in and trash the neighborhood, making it undesirable (bad bacteria). Along the way, the bad guys peer pressure others (the commensal bacteria) into trashing the hood, and you have a good neighborhood gone bad in the gut. The technical term is dysbiosis.

When the bad bacteria overtake the good bacteria, you notice symptoms such as belching, heartburn, gas, bloating, difficulty maintaining weight, constipation or/and diarrhea, candida infections, skin rashes, nail fungus, and diagnoses like IBS, SIBO, and Crohn’s.

Should I Take Probiotics?

Yes and no. If all is going well in your gut, about 85 percent of the bacteria should be the good guys. This is pretty rare these days, however. These folks do just fine including fermented foods and beverages like raw kraut and kefir (dairy or non-dairy, like water kefir) regularly to nourish their gut flora. And the carbohydrates you eat nourish your gut microbes too. But I’d say this is hardly the norm these days or even common, unfortunately. When I work with clients to heal ongoing GI issues, I’ll typically recommend that they rotate between different probiotics so they get a variety of important strains such as L. acidophilus, Bifidobacterium animalis, L.casei, Lactobacillus salivarus, bacillus coagulans, Bifidobacterium longum,  Lactobacillus plantarum and Saccharomyces boulardii.

Here are the folks that should be taking probiotic supplements:

• struggle with persistent GI issues like constipation, gas, bloating, indigestion
• working on healing leaky gut
• been diagnosed with inflammatory GI issues like gastritis or ulcers
• have multiple allergies and/or asthma
• have taken many rounds of antibiotics
• frequent yeast infections or UTIs
• recurrent diarrhea
• working on reversing autoimmune conditions
• traveling
• on a weight loss program
• you have a skin condition like eczema, psoriasis, acne
• struggle with anxiety
• babies with colic or eczema

Probiotic supplements may not be right for you if

• you’ve been diagnosed with SIBO
• they cause your digestive symptoms to worsen*

Conditions That Can Benefit from Probiotic Use

Here’s the thing: Each one of us has a gut microbiome as unique as our fingerprint. We all have different levels of the bacterial strains that live there. Certain stool tests can measure the beneficial, pathogenic, and commensal bacteria and tell us which strains are low. That’s ideal for knowing which strains to supplement with. For the rest of us who haven’t measured our gut bacteria, my go-to all around favorites are Elixia and Renew Life. Garden of Life’s Primal Defense is a good one too.

If you’re healing leaky gut and want to recolonize your gut bacteria after doing a parasite cleanse or a candida cleanse, Renew Life is a high potency, all-around excellent probiotic that’s high in the strains you want to repopulate your GI tract. This is the equivalent of the flowers and the nice new houses you want to plant and build once you’ve kicked all the bad guys out of the hood and are rebuilding.

If you’re prone to diarrhea and yeast infections, Saccharomyces boulardii is your guy. I also recommend this strain during antibiotic treatment to preserve gut health. Sac B is a yeast-eating strain of bacteria. Take this one also if you have to take antibiotics to protect your gut, but take it 6 hours away from the antibiotic. Sac b is also great if you’re doing a candida cleanse or traveling abroad and want to prevent traveler’s diarrhea. If you’re prone to candida overgrowth or yeast infections, this is an excellent probiotic for women.

If you have IBS or other inflammatory GI conditions, Elixia will intensively recolonize the gut. This high potency powder is a longer term good choice. This one is excellent for ulcerative colitis.

If you’re working on healing leaky gut, want to recolonize the gut, or just finished a round of antibiotics, I recommend starting with Elixia, then transitioning to Renew Life and then Primal Defense, which contains some soil-based organisms, for a few months. I also rotate this one in from time to time. It’s so inexpensive and works great!

A word on soil-based probiotics (or SBOs)

These guys are all the rage lately because they contain microbes from soil, which used to be a huge part of our ancestral diets. But sadly we don’t get inoculated with these beneficial strains these days. Proponents of soil based probiotics say they increase probiotic diversity in the gut and may boost immune health and even aid in reversing SIBO and IBS. But there is also a concern that because the spores in these probiotics are so hearty that they may crowd out other less hearty but crucial lactobacillus strains and potentially even turn pathogenic, worsening your gut health. There is not much research on this, so proceed with caution here. (some info here) The main strains you’ll see are bacillus species. The most popular is MegaSpore, or this Terra Flora is excellent for constipation and is typically well tolerated by SIBO folks.

This wonderful article matches specific probiotic strains (including brands) to conditions for best outcome.

Maintenance

So here’s the thing: Taking probiotics is excellent for healing your gut and boosting your immune system, but they’re not a band-aid and will not have a lasting effect alone. It’s not really like filling up your deficient gut with a probiotic supplement and continuing on your way will be effective longterm. You MUST combine probiotic supplementation with fermented foods and a microbiome-building diet. Probiotic supplements help tremendously while you are taking them, but they don’t tend to stick around and make a home in the gut. You can achieve that by eating prebiotic foods that feed your probiotics + eating fermented foods.

I also don’t recommend taking probiotics (ESPECIALLY the same brand!) longterm. It’s possible that if you continually take the same strains you can experience overgrowth in beneficial strains, which is no bueno. Once you’ve achieved your GI health goals and your digestion has improved, you can maintain your benefits by getting a good spectrum of probiotic foods. My top choices are raw kraut and fermented foods like kim chi or beverages such as water kefir. This CocoBiotic coconut water kefir is a rich source made with mineral-rich coconut water. All you need is an ounce daily or a 1/4 cup of kraut. Combine these probiotic-rich foods with prebiotic-rich foods to work on nourishing your microbiome.

Prebiotic starches feed your probiotics. Starchy root vegetables, pumpkin, honey, green tea, artichoke, onion and garlic are excellent prebiotics. Resistant starch such as green tipped bananas, potatoes, or this banana flour added to smoothies is a great choice too.

*If You Experience Uncomfortable Symptoms from Probiotics

It typically means you have very low probiotic levels to begin with, you could have SIBO, you’re taking a strain that isn’t right for you (you may have too much of it already), or you need to work up very, very slowly. There is often dysbiosis present which needs to be fixed. I typically start these folks with probiotic foods and recommend stool testing to see if there are pathogens or parasites present.

You may need to start with 1/4 tsp of kraut juice or 1/4 a capsule of probiotic and work up from there.

Conclusion

If you’re clearing up a GI infection, you want to boost your immune health, you’re working to lose weight, or you’re healing leaky gut and dysbiosis issues, probiotics are your friend. I recommend transitioning between different probiotic brands to get a better variety of strains. Once you’ve reached your goals you can rely solely on probiotic and prebiotic foods and drinks, but even then it doesn’t hurt to take a good one like Primal Defense for a month or so if you’re under stress, traveling, or feeling run down. Just remember: do not take probiotic supplements indefinitely!

Mary Vance (Certified Nutrition Consultant)

Mary Vance is a Certified Nutrition Consultant and author specializing in digestive health. She combines a science-based approach with natural therapies to rebalance the body. In addition to her 1:1 coaching, she offers courses to help you heal your gut and improve your health. Mary lives in San Francisco and Lake Tahoe in Northern California. Read more about her coaching practice here and her background here.