When Should I Take Probiotics? The Ultimate Guide to Probiotic Supplements, Part 2

Social media is exploding with ads for probiotics that claim to help everything from bloating to metabolism. To be honest, probiotics are starting to sound like a cure-all. But are they all that? 

You know me…we’re about to get all science-y. I’m not going to start taking a supplement just because somebody at the gym told me it’s good for my gut (and you shouldn’t, either!) 

In the first blog of this series, we covered some basic probiotic points like: 

  • gut colonization (no, they do not take up permanent residency in your GI)
  • strain specificity (yes, it’s important in most cases)
  • if you should take probiotics every day (as with most things in the wellness world, it depends…) 

In this blog, we’ll answer the big question: When should I take probiotics? And which probiotic do I need? 

Let’s explore some situations where you might want to consider taking a probiotic. These scenarios have been well studied and shown to be effective AND safe. 

When should I take probiotics? When you have a stomach bug

Nausea, vomiting, diarrhea? Catching a stomach bug is the worst, and most of us would do whatever is necessary to get better more quickly. Fortunately, probiotics may be just the key.

A 2010 Cochrane review found that taking a probiotic supplement during acute infectious diarrhea was effective at speeding healing. On average, participants who took a probiotic recovered 24 hours earlier than those who did not (1). Great for you, but amaaaazing if you have a pukey, poopy toddler. 

When you have a stomach bug, 24 hours can seem like a lifetime—so bring on the probiotics, please! The most effective strains seem to be Lactobacillus rhamnosus GG and Saccharomyces boulardii CNCM I-745 (2). These can be found in the common probiotics Culturelle and Florastor, respectively, available at most local drug stores. 

Pro-tip: be sure to pack these temperature-stable (meaning, no need for refrigeration) probiotics on your next trip, especially to exotic locales infamous for traveler’s diarrhea. More on that below!  

When should I take probiotics? If you are prone to yeast infections

If you are familiar with yeast infections, I just want to say—I’m sorry. And if you have never experienced the terrible itching and burning, count yourself lucky. 

There are dozens of over-the-counter medications available to ease the awful symptoms of yeast infection. Using an antifungal medication may help keep you comfortable, but it is essential to get to the root of WHY this horrible affliction is happening to you. Frequent infections are a sign that the good bacteria in your vagina and gut need help.

Two of the most well-known strains for vaginal health are Limosilactobacillus reuteri RC-14 (formerly known as Lactobacillus reuteri RC-14) and Lactobacillus rhamnosus GR-1. In vitro studies have demonstrated that L. reuteri RC-14 and L. rhamnosus GR-1 inhibit the growth of Candida in human cells (3). That’s good news for you, bad news for those annoying yeasts. 

This probiotic duo has been studied to be effective when combined with antifungal medication.

In a small double-blind placebo-controlled study of women with ongoing yeast infections treated with a one-time dose of fluconazole and probiotics or a placebo, those who received the probiotics had a 90% decrease in symptoms, compared to 65% in the placebo group (4).

A similar study found that L. reuteri RC-14 and L. rhamnosus GR-1 are also effective complementary treatments for bacterial vaginosis, also known as BV. In this study, women were given one dose of antibiotic as well as four weeks of probiotic supplements or a placebo. 

At the end of 4 weeks, 87.5% of those taking a probiotic were free of bacterial vaginosis, compared to 50% of those in the placebo group (p=0.001). 

Even more impressive, 75% of women in the probiotic group ended up with vaginal microbiota that was considered normal instead of dysbiotic, compared to 34.4% of those who only received the antibiotic (5). 

These results are pretty amazing and suggest that L. reuteri RC-14 and L. rhamnosus GR-1 have the potential to rebalance the vaginal microbiome, making vaginal infections less likely to occur. You can find this combo in Jarrow Formulas Fem-Dophilus. 

Finally, I have to include an oldie but goodie. 

A cross-over study from way back in 1992 found that daily consumption of Lactobacillus acidophilus-rich yogurt was an effective prophylactic therapy in those with recurrent yeast infections. Over a period of six months, women consumed eight ounces of yogurt each day or no yogurt. Within this period, those who had no yogurt averaged 2.54 infections. But the daily yogurt group? An average of only 0.38 infections (6)!

The yogurt eaters also saw a significant drop in Candida levels—0.84 compared with 3.23 in the non-yogurt group (6). 

A major drawback of this study is that they did not include a strain, which we know is key when it comes to probiotics. However, I can recommend Nancy’s yogurt as an excellent source of strain-specific L. acidophilus probiotics.

​When should I take probiotics? When you are traveling

Coming down with traveler’s diarrhea can ruin a vacation. It’s difficult to eat good food and see the sights when you are stuck on the toilet Googling “Immodium” in Italian. 

Luckily, taking probiotics while traveling can help prevent this undesirable situation. 

A 2019 meta-analysis and systematic review looked at three different probiotics: L. acidophilus, L. rhamnosus GG, and Saccharomyces boulardii CNCM I-74 to see if they could protect against traveler’s diarrhea (7). 

The results found that S. boulardii CNCM I-74 worked the best, significantly reducing the likelihood of getting traveler’s diarrhea (RR = 0.79, 95% C.I. 0.72–0.87, p < 0.001).

L. rhamnosus GG came in second (RR = 0.86, 95% C.I. 0.74–1.02, p<0.08), and L. acidophilus was not effective (RR = 1.14, 95% C.I. 0.95–1.37, p = 0.16) (7). 

You can find S. boulardii CNCM I-74 in the probiotic Florastor and L. rhamnosus GG in Culturelle, both of which can be found at most pharmacies. The trick is taking them before you leave and throughout your trip to give your gut the most protection.

When should I take probiotics? When you are being treated for H. pylori

H. pylori infection is extremely common, with an estimated 4.4 billion individuals infected worldwide, including up to 50% in industrialized nations (8). Many experts believe that the H. pylori bacteria has evolved with us, a weird but symbiotic relationship that may offer us the benefit of reduced risk of asthma and allergies in childhood (9).

However, overgrowth of H. pylori can lead to symptoms ranging from indigestion to gastric cancer. 

The standard course of treatment for H. pylori is antibiotic therapy plus a proton-pump inhibitor, but there is evidence that H. pylori may be developing antibiotic resistance. There is quite a bit of solid evidence showing that certain probiotic strains are beneficial at preventing and eradicating H. pylori.

Several studies have found that when Lactobacillus reuteri DSM 17938 is combined with standard H. pylori therapy, eradication of H. pylori is more likely, and there is a reduction of side effects from the antibiotics and proton pump inhibitors, such as nausea (10-12). 

You can find L. reuteri DSM 17938 in BioGaia’s Protectis and/or Gastrus probiotic supplements.

When should I take probiotics? When you are pregnant (to prevent group B strep)

If you have ever been or plan to be an expectant mother, you are probably familiar with the routine group B strep test given during the last trimester. If positive, it means antibiotics are required during labor. If you are someone who understands the potential adverse effects of antibiotics, this can certainly be a source of stress during an already overwhelming time. 

However, what you might not have learned in your prenatal care is that taking certain probiotics can help prevent group B strep and even get rid of it if you test positive (13). One meta-analysis found that taking a probiotic during pregnancy can reduce group B strep by 44%. 

In 2016, a placebo-controlled trial was conducted on 99 pregnant women who tested positive for group B strep during weeks 35 to 37 of pregnancy. They were instructed to take either a probiotic containing  L. rhamnosus GR-1 and L. reuteri RC-14 or a placebo daily until delivery. When they were retested before delivery, 42.9% of the probiotic group tested negative for group B strep, compared to 18% in the placebo group (14). 

These results show us that taking a strain-specific probiotic can be an easy way to prevent unwanted antibiotics during labor for many pregnant people. The probiotics above can be found in Jarrow Formulas Fem-Dophilus. 

When should I take probiotics? If you have celiac disease

Finding out you have celiac disease (CD) can be a serious curve ball. Suddenly you have to completely change your diet, which can be a huge challenge. But what happens when you go totally gluten-free and continue to have gut symptoms? It’s estimated that 30% of CD individuals still have gut symptoms even after going gluten-free.

There are a handful of reasons behind lingering gut symptoms, but one reason is the dysbiosis of gut bacteria. 

Researchers investigated if a probiotic supplement would help strictly gluten-free CD folks with persistent gut symptoms. After six weeks, there was an average of 15% reduction in IBS-type symptoms (in comparison to the placebo group’s symptoms that worsened by an average of 8%), and gastrointestinal symptoms decreased by an average of 19.8% (the placebo group’s symptom severity increased by 12.9%) (15). 

The probiotics also had long-lasting effects—they increased the amount of a beneficial bacteria called Bifidobacterium, a big bonus that was still observed six weeks after discontinuing probiotic supplementation (15). 

The probiotic used in this study was a combination of Lactobacillus casei LMG 101/37 P-17504, Lactobacillus plantarum CECT 4528, Bifidobacterium animalis subsp. lactis Bi1 LMG P-17502, Bifidobacterium breve Bbr8 LMG P-17501, and B. breve Bl10 LMG P-17500. 

Unfortunately, there isn’t currently a product available in the US with these strains, but hopefully, a formula is on the horizon. If you’re located in Italy, these strains are sold as Pentabiocel

When should I take probiotics? When you are chronically constipated

Functional constipation, also called chronic constipation, affects an estimated 30% of people in North America and is typically defined as having less than three bowel movements a week as well as having hard stools that are difficult to pass. 

Chronic constipation can be very uncomfortable and greatly affect quality of life. There are many factors that can lead to chronic constipation. Diet, nutrient and hydration status, and stress are often significant contributors. Gut microbiota also play a role in gut motility and the likelihood of being constipated. 

The research shows that probiotics can help resolve chronic constipation for some people. 

A randomized, controlled study of 1,248 adults with constipation found that four weeks of supplementation with Bifidobacterium animalis subsp. lactis BB-12 increased the frequency of bowel movements to four times per week, improved Bristol stool scores, and reduced abdominal bloating and discomfort (16). 

The probiotic group experienced significantly greater results than the placebo group, but Interestingly, there was a pretty large placebo effect in this study. Meaning the group that took the placebo also experienced less constipation, abdominal pain, and bloating. Placebo effects are not uncommon for those with IBS-type symptoms. In our next blog in the series, we will dig into this more, including if probiotics should be taken for IBS-C and those with IBD. 

And finally, remember to take probiotics with food!

No matter why you are taking a probiotic, taking it with food helps ensure its survival through your GI tract due to the increase in pH after eating. You want to make sure that all those good microbes can reach your intestines and do their best work.