Will taking a probiotic supplement

improve your health? Irritable Bowel Syndrome

A large body of research shows that
probiotics are beneficial for a surprisingly
(IBS)
wide variety of conditions. I’ve
Probiotics have been shown helpful for
summarized evidence from more than
the symptoms of IBS, which include
500 studies in this chart.
constipation, loose stools, diarrhea,
abdominal pain and gas.

Probiotics Improve These Conditions ● Two meta-analyses, involving more

than 1,100 patients, have shown
High level of scientific support for:
probiotics to be an effective
treatment for IBS, with no side
effects. 1 2
IBS IBD Mood
Gas, bloating, Crohn’s and Depression and
diarrhea, ulcerative colitis anxiety
● Another meta-analysis, 3 involving
constipation, 1,404 patients showed
abdominal pain improvement in global IBS
symptoms when compared to the
Gut Leaky gut Infections placebo group.
Imbalances Gut damage & Vaginal
SIBO, H. pylori, permeability infections, Based on this compelling data, the
candida/fungus, urinary tract
pathogens infections, tooth
Canadian Association of Gastroenterology
decay Clinical Practice Guideline for the
Management of Irritable Bowel Syndrome
Limited, but encouraging, scientific support recommend a trial on probiotics for IBS. 4
for:

Cognition Hormonal Allergies

Gut Imbalances: SIBO, Leaky
Cognitive
function, brain
Health
Thyroid health,
Dairy
intolerance, Gut, Fungus, H. pylori &
Infection
fog PCOS, seasonal
endometriosis, allergies
bone density

Small Intestinal Bacterial

Autoimmune Metabolic Sleep
Conditions Health Sleep quality Overgrowth (SIBO)
Type 1 diabetes, Blood sugar, and disruption
multiple cholesterol, Some claim you should not take
sclerosis, blood pressure, probiotics for SIBO because you already
rheumatoid weight loss
arthritis
have too much bacteria. However,
probiotics have been CLEARLY shown to
be effective in treating SIBO, both in
improving symptoms and in improving
Let’s take a closer look at each of these lab values. 5
conditions:
● One study found probiotics to be
more effective than the antibiotic
metronidazole (a standard
treatment for SIBO). 6
 ● A meta-analysis summarizing 18 ● One review found that probiotics
clinical trials concluded that worked as well as the
probiotics are an effective anti-inflammatory drug, mesalamine,
treatment for SIBO. 5 Specifically, in maintaining remission for Crohn’s
probiotics reduce bacterial disease. 13 Best results were for a
overgrowths and hydrogen combination of probiotics and
concentrations, and improve mesalamine.
symptoms including abdominal ● Another review found the best
pain. approach for treating active ulcerative
colitis was a probiotic supplement
Another exciting study found that
combined with an anti-inflammatory
probiotics work substantially better in
drug. 13
patients with both IBS and SIBO, as
● Other reviews have found probiotics
compared to those who have IBS without
to be equally effective for ulcerative
SIBO. 7
colitis as anti-inflammatory drugs like
Leaky Gut mesalamine. 14
● One systematic review has found
One small clinical trial found that probiotics do not help maintain
probiotics helped to promote intestinal remission, but overall the data
repair in humans. 8 Another trial found suggest probiotics are helpful. 15
positive effects of probiotics when used
to treat intestinal impairment after a GI
infection. 9
Antibiotic-Associated
Fungus, Candida and Parasites
Diarrhea
The prestigious Journal of the American
Probiotics don’t just fight bad bacteria. Medical Association published a
They are antifungal and antiparasitic: meta-analysis of 82 randomized control
● In a study of 181 infants, probiotics trials. They found that probiotics work to
were as effective as Nystatin (a reduce antibiotic-associated diarrhea. 16
standard antifungal medication) in Three additional meta-analyses found
reducing fungal infection and similar results. 16 17 18
improving food intolerances. 10
● Two studies show that probiotics Traveler’s Diarrhea
can be more effective than A systematic review and meta-analysis
standard antiparasitic drug found S. Boulardii prevented travelers
treatment in Blastocystis hominis diarrhea. 19
and Giardia infections. 11 12
Constipation
Inflammatory Bowel Disease Three recent and very-high quality studies
recently combed through the available
(IBD) research into probiotics for constipation
Research shows that probiotics are very and both found that probiotics
helpful for IBD (ulcerative colitis or significantly increase stool frequency and
Crohn’s disease): gut transit time. 20 21
The research also showed that multistrain
probiotics were more effective than single
strain probiotics for increasing stool Brain Fog & Cognitive
frequency, improving stool consistency
and reducing bloating. Function
Data here are preliminary but
Mood, Depression & Anxiety encouraging:

Inflammation in the intestines can also ● Research has found increased brain
cause inflammation in the brain. That’s fog, aka lack of coherence, in those
why probiotics can aid with mood with IBS. 26
problems like depression and anxiety. We ● Since there’s impressive evidence that
call this the gut-brain connection. Here’s probiotics can improve, we can draw a
the research: tenable inference that if IBS occurs
with brain fog, reducing IBS could
● In a meta-analysis of 10 clinical reduce brain fog.
trials with a total of 1,349 subjects,
probiotics were associated with A 2020 Meta-analysis looked at 7 human
significant improvements in the and 11 animal studies. Researchers
moods of individuals with mild to concluded that probiotics enhanced
moderate depressive symptoms. 22 cognitive function. Effects of probiotics on
This effect was not seen in healthy cognitively impaired individuals were
individuals. greater than those on healthy ones. 27

● Two more systematic reviews with Brain fog, or fuzzy thinking, isn’t usually
meta-analysis of clinical trials have studied in isolation but we can look at
found probiotics lead to a other disease-model studies where
significant reduction in depression. probiotics have improved cognition,
23 24 including:

● One review found that probiotics ● Alzheimer's 28 29

were especially beneficial in ● Bipolar disorder 30
patients with major depressive ● Fibromyalgia 31
disorder. 24 In addition, multiple
strains of probiotics were more Sleep
effective in reducing depressive
symptoms. 24 The research data for probiotics and
sleep quality is limited but encouraging:
● There is also data showing anxiety
can be improved from probiotics. ● In a 2 year trial of medical students,
The data here are not as strong, those who took probiotics showed
but still have documented an superior sleep quality during times of
anti-anxiety effect, in human exam stress. 32
clinical trials. 25 ● In a clinical trial, participants reported
that their sleep quality improved after
So, if you have depression or anxiety, 6 weeks of taking probiotics. 33
probiotics may help. If your mood is fine, ● Another clinical trial of IBS patients
then they won’t. showed sleep improvements for
diarrhea-type IBS patients. The same
results were not seen for
 constipation-type mixed-type IBS ● Increased inflammation
patients. 34 ● Autoimmunity
● An additional study of subjects with
depression showed that the group
taking probiotics had less sleep
Metabolism
disruption than the placebo group. 35 This has not been studied robustly yet,
but from the preliminary data we do
Autoimmunity have, it does appear that SIBO affects
metabolism:
This is another area where data is sparse
● Two studies support the connection
but encouraging. These are highlights
between SIBO and metabolism. In
from a research review that explored
these studies, patients who tested
probiotic treatment and autoimmune
positive for SIBO had higher BMI
disease. 36
scores than patients without SIBO. 42 43
However, not all the data show SIBO
Type 1 Diabetes correlates to weight gain. 44
● Two other studies suggest that
● In a large study of 7,473 children at
risk for type 1 diabetes, early probiotic methane-producing bacteria, M.
supplementation was shown to smithii (found in SIBO patients), may
reduce the risk of autoimmunity when help you to extract extra calories from
compared to children who had not your diet, leading to weight gain. 45 46
taken probiotics early in life. 37 ● Finally, preliminary evidence that
shows treating SIBO may help
improve blood sugar, cholesterol, and
Multiple Sclerosis (MS) even reduce weight. 47
A double-blind study of 60 MS patients, This is a semi-inferential connection,
found that patients treated with however the evidence seems to suggest
probiotics showed less disability, lower that SIBO patients who use probiotics
insulin resistance and fewer inflammatory may achieve metabolic improvements
markers. and weight loss.

Rheumatoid Arthritis (RA) Food Allergy & Seasonal

● Three different studies found mixed
results for probiotics in RA disease
Allergy
activity. One study did not show There’s good news for people who suffer
significant improvement while two with allergies:
other studies did show improvements.
38 39 40 ● A systematic review of 15 clinical trials
found that probiotics can improve
The authors of this research review noted dairy tolerance. 48
that intestinal dysbiosis is seen in ● A meta-analysis of 22 randomized
autoimmune disease. 41 Specifically, control trials concluded that probiotics
autoimmune patients have: can improve seasonal allergy. 49
● Decreased bacterial function and ● Other high-quality studies support
diversity similar findings. 50
● Impaired gut barrier function
There is also data, albeit mixed, results are a bit mixed, however the
suggesting that probiotics given to majority of results do show benefits
children may prevent or reduce formation
● Four meta analyses involving 68
of allergy. 51 52
clinical trials and 3885 patients found
that probiotic supplements can
Female Hormones improve overall cholesterol profiles.
One of these studies also shows
We don’t have good data regarding
significant improvements to blood
female hormones and probiotics, but we
pressure. 57 58 59 60
can make some inferences based on
● Another meta analysis evaluated 9
other research:
clinical studies with 678 pre-diabetic
● We know that the gut microbiota is participants and found probiotics had
involved in regulating estrogens and a significant effect on reducing LDL
that gut dysbiosis can disturb Cholesterol. However, there was no
estrogen levels. 53 effect on blood pressure or any other
● A research review and one additional cholesterol readings. 61
study indicates that women with ● Another study found that probiotics
PCOS, obesity, endometriosis, can lower homocysteine, 62 which is an
cardiovascular disease, and breast independent risk factor for heart
cancer have lower diversity in their disease.
intestinal bacteria. 53 54 All of these
The amount of improvement found in
conditions are all associated with
these studies is usually small, but
unbalanced estrogen levels.
favorable. So, probiotics should not be
● One study found that probiotics plus
viewed as the primary therapy for high
soy isoflavones improved bone
cholesterol or blood pressure.
density. 55

Thyroid Function
● Preliminary evidence suggests that
these types of health conditions can
improve when bacterial diversity in
There is significant research that
the gut increases. 53 This is where
demonstrates a gut-thyroid connection:
probiotics may come in.
● A large and fascinating study
One very recent meta-analysis confirms
investigated the health conditions that
that we are on the right path with these
are most commonly found in patients
inferences. 56 The authors looked at 13
with SIBO. 63 Being hypothyroid or
studies involving 855 women and found
on thyroid medication were the
that probiotic use improved hormonal
most highly associated with SIBO.
and inflammatory markers for women
with PCOS. ● Another study 64 also found that
thyroid autoimmunity was higher in
Blood Pressure & Cholesterol those with SIBO as compared to
healthy controls. Thyroid
When it comes to blood pressure and autoimmunity is the underlying cause
cholesterol, we have five meta analyses in most cases of hypothyroidism.
(the highest quality of research data ● A recent meta-analysis concluded that
available), so this is worth a look. The there is an association between the
 bacteria H. pylori and thyroid ● Less colic and irritability,
autoimmunity. 65 ● Less diarrhea,
● Fewer spitting episodes
Since we know that probiotics are
● Fewer respiratory infections
effective for treating gut imbalances like
SIBO and H. pylori, probiotics may be an Researchers have also found benefits for
effective therapy for improving thyroid preterm infants. Probiotics were
health. associated with lower rates of mortality
and necrotizing enterocolitis (NEC)
Skin Health mortality. This points to the safety and
efficacy of probiotics in high-risk
Is there a gut-skin connection? Here’s a populations. 75
look at the evidence:
Women who took probiotics during
● The skin and the gut have pregnancy had fewer incidences of: 76
similarities in their structure, they
● Gestational diabetes
play similar roles in immune
● Pre-eclampsia (high blood
function and both host a diverse
pressure during pregnancy)
bacterial population. 66
● Excessive weight gain
● Evidence suggests that intestinal
● Vaginal bacteria infections
health and skin health are closely
linked. 67 68 More studies show that probiotics:
● A recent review paper summarized ● Appear safe for infants and even
the research into acne and the preterm infants 75 77 78
microbiome and confirms the
connection. 69 ● Protect infants against intestinal
● 2 clinical trials showed that topical fungus (candida) overgrowth 79
probiotic treatments were effective ● Reduce the risk of ear and
for treating acne. 70 71 respiratory infection in babies 80
● Another study compared ● Reduce colic
traditional antibiotic therapy for ● Reduced symptoms of allergic
acne with a probiotic supplement. rhinitis 52
The young women in both groups
showed significant improvement ● Are beneficial as part of a
after 4 weeks. A third group that treatment program for newborns
was treated with both antibiotics with jaundice 81
and probiotics had the best
results. 72
● A systematic review suggests that Why Do Probiotics Help So
a combination of oral and topical
probiotics may be most helpful for Many Different Conditions?
skin conditions such as rosacea,
acne, and atopic dermatitis. 73 The Journal of Clinical Gastroenterology 82
and the journal Trends in Microbiology 83
Infant & Mom Health offer insights regarding how probiotics
make you healthier.
Researchers have found benefits from
Probiotics can:
probiotic use for infants, including: 74
 ● Increase bacterial diversity, or
health, of your bacterial Quality Matters - Don’t Buy
●
community 84
Fight pathogens (harmful bugs) Junk!
and their toxins
● Promote a more rapid recovery When it comes to buying probiotic
from imbalances in your gut supplements, quality assurance practices
organisms do matter. Probiotic manufacturing is not
● Promote a healthy immune highly regulated and some labels claims
response in your gut 85 86 do not stand up to scrutiny. Consider the
● Reduce gut inflammation results of these investigations into
(remember excessive inflammation is probiotic quality:
part of an overzealous immune
● Of 26 commercial probiotics
response) 84
assessed in this study, none fully
● Encourage the growth of healthier
supported label claims, and some
microbes in your gut 85
of them contained unacceptable
● Reduce leaky gut aka damage to
microorganisms. 89
your gut lining. 9 87 88
● These researchers conclude that
Said simply, probiotics can help improve
two common problems in
the balance of organisms in your gut,
probiotic supplements are a low
reduce overzealous immune system
concentration of viable cells (i.e.
activity and reduce the inflammation
you're getting ripped off) and the
which many of us suffer with.
presence of undesired (potentially
Unhealthy Gut Bacteria = harmful) organisms. 89
Inflammation ● One study found only half of the
probiotics examined had the
Inflammation = Symptoms specific strain listed on the label. 90
You may be surprised to know how many ● Another study found 43% of the
common conditions are caused by probiotics assessed contained less
inflammation. Modern-day inflammatory than half the amount of probiotic
conditions include): listed on their labels. 89
● Fatigue If a company follows quality assurance
● Depression or Anxiety practices, a probiotic supplement will
● Brain Fog meet its label claims and not contain
● Insomnia potentially harmful organisms.
● Acne or Other Skin Conditions
● Female Hormone Imbalances What to Look for in a Probiotic
● Male Hormone Imbalances
Supplement
● Hypothyroid Symptoms
● Immune System Dysregulation and Independent Laboratory Analysis
Autoimmunity
All probiotic raw materials and final
products undergo independent
laboratory analysis ensuring probiotic
quality and fulfillment of GMP
requirements. This ensures the probiotic
meets its label claims. How to Find the Right
Genetic Identification
Probiotic for You
To ensure the strain of probiotic meets
the label claim, thus protecting you from Taking probiotics doesn’t need to be
using frankenstein probiotics or harmful complicated. Yes, there are a lot of
organisms. Harmful organisms are one of different probiotic strains, but all you
the most common problems with really need to know are the three main
probiotics. probiotic categories. Nearly every
probiotic product can be classified into
Free of Major Allergens
one of these categories. 91
Probiotics should be grown on media
which are free of the common allergens: CATEGORY 1 CATEGORY 2 CATEGORY 3
wheat, gluten, milk, casein, eggs, fish,
shellfish, tree nuts, peanuts and Lactobacillus & Saccharomyces Soil-Based
soybeans. A quality probiotic will also be bifidobacterium Boulardii Probiotics
species using various
free of artificial colors, flavors, or predominated
(a healthy
Bacillus species
fungus)
preservatives. blends

Validated Potency
These are the The second The third most
Probiotics should always meet their lab's most most researched researched
claims upon testing. Certain probiotics well-researched, probiotic, with category of
with over 500 over 100 probiotics is
should be stored by the manufacturer trials assessing studies. soil-based
and shipped in refrigerated conditions to their validity. Saccharomyces probiotics. This
retain the potency list on the label claims. These live boulardii (S. group has
microorganisms boulardii for roughly 14
Good Manufacturing Practices (GMP) in are also known short) is not a clinical trials
Manufacturing as lactic-acid normal part of evaluating their
producing human effectiveness.
GMP are a set of best practices for dietary probiotic microbiota, This category is
supplement manufacturing in the United bacteria. They meaning it does also known as
typically do not not colonize us spore-forming
States. This includes utilizing a colonize the but does bacteria. This
state-of-the-art facility where host, but do improve the category of
temperature and air quality are tightly improve the health of the probiotic can
health of the host. colonize the
controlled. This produced a consistent host. host. 92
quality and purity of product.
You don’t need to purchase the most
expensive probiotic supplements. But, This is great news. This means you don’t
you should be wary of a probiotic that need to try every probiotic strain on the
is substantially cheaper than the rest. market, but rather you can pay attention
This usually indicates corners have been to the category and pick one quality
cut in the quality assurance standards. formula from each.
All three of the probiotic supplements You also don’t need to match specific
that I sell and also use in my practice, probiotic strains to specific symptoms. All
meet these quality standards. probiotics work in a similar way by
addressing the underlying reasons for
your symptoms.
 treatment of IBS, the systematic reviews
Take Probiotics When It’s and meta-analyses indicated that the

Convenient for You multi-strain probiotics were more

effective than single-strain probiotics. 93 94

Despite advice that you might read Multistrain probiotics were also found to
elsewhere, taking probiotics is simple: perform better in a meta-analysis of
studies using probiotics to treat
● You can take them with or without constipation. 21
food.
● You can take them at any time of A meta-analysis found that multiple
the day. strains of probiotics were more effective
● You can (and should) take than single strains in reducing depressive
probiotics with antibiotics. symptoms. 24

What you need to do – easy as

Triple Probiotic Therapy 1, 2, 3
1. Try a quality formula probiotic from
category 1, category 2 and category 3 -
take all three together.
2. Monitor your symptoms for 3-4
weeks. If you’re improving, stay on the
Triple Probiotic Therapy protocol until
your improvements have plateaued.
● Once you’ve seen your maximum
improvement (you’ve plateaued),
stay here for about a month to
allow your system to calibrate to
these new improvements. Then
reduce your dose and find the
minimal effective dose. Stay on
the minimal effective dose.
If you haven’t noticed any change in your
symptoms after 3-4 weeks, you can stop
Many people don’t seem to achieve
taking probiotics and feel confident that
balance in their microbiota with just one
you have fully explored probiotic therapy.
strain of probiotic. Some lucky people do,
There’s no need to go shopping for other
but for many, one probiotic won’t suffice.
probiotic strains.
I have seen the best results with my
patients following a protocol that includes
all three probiotic categories. For many
patients who have tried probiotics in the
past, this approach makes all the
difference.
Research supports this approach to
taking probiotics. When mixtures of
several probiotics were compared with
single strains of probiotics in the
Probiotics from Food
Diet is a great source of probiotics. Below is a table of common foods that are high in
probiotics compared with probiotic supplements. As you can see, a challenge with diet is
that it is difficult to obtain the same dose used in the research studies.

Food Species Amount Equivalent Dose

Sauerkraut Leuconostoc mesenteroides 3 billion CFU ⅛ capsule

Lactobacillus brevis per cup Lacto-Bifido Blend
Pediococcus pentosaceus Probiotic
Lactobacillus plantarum

Yogurt 95 96 Lactobacillus acidophilus 2.5 billion CFU 1/10 capsule

Streptococcus thermophilus per cup Lacto-Bifido Blend
Lactobacillus delbrueckii subsp. Probiotic
bulgaricus

Lacto-fermented Lactobacillus casei 1.3 billion CFU .05 capsule

Pickles 97 98 Lactobacillus rhamnosus per pickle Lacto-Bifido Blend
Lactobacillus plantarum Probiotic
Lactobacillus brevis

Kefir 99 Lactobacillus brevis 2.5 billion CFU 1/10 capsule

Lactobacillus acidophilus per cup Lacto-Bifido Blend
Lactobacillus casei Probiotic
Lactococcus lactis
Saccharomyces cerevisiae

Kimchi 100 101

Weissella koreensis 11.5 billion CFU ½ capsule
Lactobacillus sakei per ½ cup Lacto-Bifido Blend
Lactobacillus graminis Probiotic
Weissella cibaria
Leuconostoc mesenteroides

For optimum results with probiotics, consider adding probiotic supplementation to your
diet.

Keep in Mind...
Probiotics can be very helpful for a variety of health conditions, however they are not a
cure-all and sometimes other, more advanced, therapies are needed. If this interests you,
please see Healthy Gut, Healthy You which provides a detailed guide for what else you can
do to heal your gut beyond probiotics.
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