This is a very common question I hear in my professional life, as well as in my personal life.  We know that we have bacteria residing in our intestinal tract, both good (beneficial) and bad (pathogenic).  Ideally, the beneficial bacteria should outnumber the pathogenic at a ratio of about 85:15.  It is thought that we have over 500 species of bacteria in our guts that work to help to ward off pathogens, strengthen the immune system, and help break down food.  The most common beneficial bacteria are lactobacilli and bifidobacteria.

Beneficial bacteria support the mucosal lining of the gastrointestinal (GI) tract, which helps to maintain the GI barrier function.  They support immune health by enhancing B-cell, T-cell, and NK cell function (pureencapsulations).  Good bacteria can prevent over-colonization of the gut with pathogenic organisms and may decrease the risk of some GI diseases.  They have been found to ward off yeast infections, allergies, and might even reduce stress, depression, and anxiety.  Probiotics can be particulary helpful with irritable bowel disease.

So, should you take a probiotic or not?  I generally only recommend supplementing with probiotics when there is a GI issue.  I have seen improvement with probiotic use in my practice with many conditions, including diarrhea, constipation, gas, bloating, vaginal yeast infections, and rashes.  I always recommend probiotics during and after antibiotic use. During bouts of diarrhea, you should take a probiotic after each episode. Also try probiotics during times of stress, allergy seasons, and infections.

The follow-up question to, “should I take a probiotic”, is “how do I take a probiotic”.  The minimum dose for a probiotic capsule is 10 billion colony forming units (CFUs).  Probiotics should be taken at bedtime and/or 1 hour before a meal or 2 hours after a meal.  The goal is to have the GI tract as empty as possible so that the bacteria have more places to set up camp.  During antibiotic regimens, take the probiotic between doses. After a short time, the antibiotic enters the blood stream leaving the gut open for the probiotics to re-colonize. You should also stay on probiotics for a few weeks after taking the antibiotic.  Probiotics have been shown to be safe even at very high doses.  Be sure to always buy a high quality probiotic from a reputable source. Companies who make effective probiotics spend a great deal of money and energy into the timing, temperature, and shipping, and insist on proper storage by retailers.

If you are not having a health concern, but want to be sure your level of beneficial bacteria is adequate, you can add fermented foods to your diet.  This includes fermented dairy like yogurt and kefir, as well as natural pickles and sauerkraut.  I have picked up some delicious sauerkrauts, such as those made in Indianapolis by Fermenti Artisan at our local health food co-op.  They are quite delicious and can be added to salads, sandwiches, etc.  You can also add more starchy fruits and vegetables to your diet, such as onions, asparagus, chicory, banana, and artichokes.  These encourage the production of fructooligosaccharides (FOS), which appear to stimulate the production of beneficial bacteria in the gut.

Finally, if you are having a GI issue that is not resolving with conventional treatments or by adding a probiotic, consider a comprehensive stool analysis, such as the GI effects by Genova Diagnostics.  This is the test I use with my patients and is one of my favorite tests I offer.  It provides a count of the beneficial bacteria, as well as determines the presence of pathogenic bacteria and parasites, and offers information regarding digestion, absorption, and inflammation.

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