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The International Scientific Association for Probiotics and Prebiotics advises manufacturers to list the total number of CFUs—ideally for each strain—on the expiration or use by date on the product label [ 76]. The association also suggests that consumers of these supplements avoid products that list the number of CFUs at time of manufacture because this information does not account for declines in CFUs over a product’s lifespan. References Tavakoly R, et al. (2021). Effect of probiotic consumption on immune response in athletes: A meta-analysis. And there's likely to be a huge difference between the pharmaceutical-grade probiotics that show promise in clinical trials and the yoghurts and supplements sold in shops. Kothari D, et al. (2019). Probiotic supplements might not be universally-effective and safe: A review.
Probiotics usually exert their effects in the gastrointestinal tract, where they may influence the intestinal microbiota. Probiotics can transiently colonize the human gut mucosa in highly individualized patterns, depending on the baseline microbiota, probiotic strain, and gastrointestinal tract region [ 4]. The gut microbiota play an important role in nutrient and energy extraction from food. Research in mice suggests that the gut microbiota affect not only use of energy from the diet, but also energy expenditure and storage within the host [ 58]. Whether these effects translate to humans is unknown. Effective dose: With the exception of one product (which doesn’t use CFUs), all the supplements below contain at least 10 6 (1 million) CFUs per gram. Sun K, et al. (2022). The effect of probiotics on the serum lipid levels in non-obese healthy adults with hyperlipidemia: A systematic review and meta-analysis of randomized controlled trials.Studies indicate that probiotics may help improve multiple types of diarrhea, including infectious diarrhea, antibiotic-associated diarrhea, and traveler’s diarrhea.
Wang Y, Florez ID, Morgan RL, Foroutan F, Chang Y, et al.. Probiotics, Prebiotics, Lactoferrin, and Combination Products for Prevention of Mortality and Morbidity in Preterm Infants: A Systematic Review and Network Meta-Analysis. JAMA Pediatr. 2023 Oct 2:e233849. [ PubMed abstract] The microbiome is made up of many different species of bacteria, some of which are considered friendly and others termed pathogenic. The bacteria line the gut wall and help to stop toxins and harmful substances passing through the gut into the body – so ideally, we need a lot more good than bad. The ideal ratio has been estimated at 85% good to 15% bad bacteria and if this balance is affected it may lead to digestive symptoms such as bloating or irritable bowel syndrome (IBS). This bacterial balance may be affected by a number of factors, including hormonal changes (particularly menopause), menstruation, childbirth, gut bacteria, sexual activity, contraceptives, and antibiotics. Multi-strain live bacteria, including three Lactobacillus strains Caffarelli C, Cardinale F, Povesi-Dascola C, Dodi I, Mastrorilli V, Ricci G. Use of probiotics in pediatric infectious diseases. Expert Rev Anti Infect Ther 2015;13:1517-35. [ PubMed abstract] May improve cardiovascular risk factors: Probiotic supplements may help reduce blood lipid levels in some people, which may decrease the risk of heart disease. However, evidence is limited at this time.Yang Bo MM, et al. (2019). A meta-analysis of the effects of probiotics and synbiotics in children with acute diarrhea. ProVen Probiotics, Unit 2 Christchurch Road, Baglan Industrial Park, Port Talbot, SA12 7DJ. Tel: 01639 825107 Products labeled “1 x 10 9 CFU” contain 1 billion viable or live bacteria per dose. Most supplements contain 1–10 billion CFUs per dose, but some contain much larger amounts. Whether different strains of probiotic bacteria have beneficial effects on IBS probably depends on the IBS symptom being evaluated [ 48]. In a meta-analysis of 10 RCTs with a total of 877 adults treated with probiotics or placebo for 4 weeks to 6 months, pain scores improved significantly with administration of probiotics containing Bifidobacterium breve, Bifidobacterium longum, or Lactobacillus acidophilus species compared with placebo treatment [ 49]. In contrast, Streptococcus salivarius ssp. thermophilus, Bifidobacterium animalis, Bifidobacterium infantis, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus bulgaricus, and Saccharomyces boulardii had no significant effect. The abdominal distension scores improved with use of probiotics containing Bifidobacterium breve, Bifidobacterium infantis, Lactobacillus casei, or Lactobacillus plantarum species. Flatulence declined with use of all tested probiotics, but the studies showed no positive effect of probiotics on quality of life.
Mohajeri MH, et al. (2018). The role of the microbiome for human health: From basic science to clinical applications. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Notably, Lactobacillus acidophilus was present in all of the multistrain supplement studies that reported significant improvements. Probiotics also exert health effects by nonspecific, species-specific, and strain-specific mechanisms [ 1]. The nonspecific mechanisms vary widely among strains, species, or even genera of commonly used probiotic supplements. These mechanisms include inhibition of the growth of pathogenic microorganisms in the gastrointestinal tract (by fostering colonization resistance, improving intestinal transit, or helping normalize a perturbed microbiota), production of bioactive metabolites (e.g., short-chain fatty acids), and reduction of luminal pH in the colon. Species-specific mechanisms can include vitamin synthesis, gut barrier reinforcement, bile salt metabolism, enzymatic activity, and toxin neutralization. Strain-specific mechanisms, which are rare and are used by only a few strains of a given species, include cytokine production, immunomodulation, and effects on the endocrine and nervous systems. Through all of these mechanisms, probiotics might have wide-ranging impacts on human health and disease. While products are not routinely tested for purity and potency by a third-party lab, the company states that it takes multiple measures to ensure quality and safety. Researchers have studied the use of probiotics to improve lipid profiles. The mechanisms of their effects on cholesterol concentrations include catabolism of cholesterol by increasing: Antibiotics are another common cause of acute-onset diarrhea. Antibiotic treatment often disturbs the intestinal microbiome and, by decreasing microbial diversity, can lead to a loss of microbial metabolism (resulting in osmotic diarrhea due to excessive fluid in the intestine), loss of colonization resistance (resulting in increased numbers of infections by other pathogens), and increased intestinal motility [ 25]. Up to 30% of patients who use antibiotics experience AAD [ 26].
Lorenzo-Zuniga V, Llop E, Suarez C, Alvarez B, Abreu L, Espadaler J, et al. I.31, a new combination of probiotics, improves irritable bowel syndrome-related quality of life. World J Gastroenterol 2014;20:8709-16. [ PubMed abstract] Bea J-M. (2018). Prophylactic efficacy of probiotics on travelers’ diarrhea: an adaptive meta-analysis of randomized controlled trials. Results of clinical trials that assessed the impact of probiotics on obesity-related endpoints have been inconsistent. One 12-week clinical trial, for example, randomized 210 healthy adults age 35 to 60 years who had large amounts of visceral fat to consume 200 g/day fermented milk containing 10 7, 10 6, or 0 (control) CFU of Lactobacillus gasseri SBT2055 (LG2055) per gram of milk [ 59]. Participants who received 10 7 or 10 6 CFU/g milk of Lactobacillus gasseri experienced significant reductions in visceral fat area (mean reductions of 8.5% and 8.2%, respectively), body mass index, waist and hip circumference, and body fat mass compared with the control group. In another randomized clinical trial, daily supplementation with 3.24 x 10 8 CFU Lactobacillus rhamnosus CGMCC1.3724 for 24 weeks combined with an energy-restricted diet for the first 12 weeks (500 kcal/day less than estimated calorie needs) did not significantly affect weight loss compared with placebo in 125 adults age 18 to 55 years with obesity [ 60]. However, the Lactobacillus supplementation did significantly reduce body weight after 12 weeks (loss of 1.8 kg) and 24 weeks (loss of 2.6 kg) compared with placebo in the 77 female participants. However, the authors of a more recent review of the influence of probiotics on blood lipid profiles of healthy adults (in 14 studies with a total of 942 adults treated from 15–150 days) found insufficient evidence to conclude that probiotics improve blood lipid levels [ 56]. Another review found that use of probiotics containing multiple strains produced statistically significant reductions in total and LDL cholesterol levels (by 12.0 and 20.1 mg/dL, respectively), whereas trials that used a single strain did not [ 57].Research into the role of the microbiome in health has to date included studies on digestive issues such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), immunity (including allergy, respiratory tract infections and autoimmunity), the gut-brain axis and general areas of health, such as energy and weight.
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