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Am Fam Physician. 2017;96(3):online

See related article on probiotics for gastrointestinal complications.

What are probiotics?

Probiotics are organisms (bacteria and yeasts) that are taken to improve health.

Why should I use them?

Our bodies are home to trillions of organisms. The right variety of these organisms can keep us healthy. Different types of organisms have different jobs. Some keep us healthy by fighting other disease-causing organisms. Others interact with immune cells to reduce inflammation or prevent allergic reactions.

Good, health-protecting organisms are fed by certain foods. When we eat, organisms in our gastrointestinal (GI) tract eat too. Sometimes, the numbers of good organisms can get low (for example, if you have diarrhea or if you take antibiotics). When this happens, taking probiotics may help increase the number of good organisms in your GI tract.

Which GI conditions can be improved with probiotics?

Probiotics can help if you have diarrhea after using antibiotics, Clostridium difficile–associated diarrhea, ulcerative colitis, or irritable bowel syndrome (IBS). They can also help with colic in infants. See the table for a list of products to use for specific GI conditions.

Which GI conditions are not improved with probiotics?

Probiotics are probably not helpful if you have pancreatitis or Crohn disease.

Which species of probiotics are helpful?

Some of the probiotic species that have shown benefit include Bifidobacterium, Lactobacillus, Leuconostoc, Saccharomyces boulardii, and Streptococcus.

What are the risks of taking probiotics?

Probiotics are considered safe for most people (infants, children, adults, and older persons). However, they may cause problems in people with cancer or people who do not have a normal immune system. Rarely, probiotics have caused a serious blood infection in people with cancer.

What should I know when buying probiotics?

It is important to read the label. Think of three “Ds”: diversity, dose, and delivery.

  • Diversity means that there are a lot of different species included, not just one.

  • Dose is measured in colony-forming units (CFUs). You should aim for at least 10 billion CFUs per species.

  • Delivery is the way that you take the probiotic. Enteric-coated capsules make it more likely that more probiotic cells will reach your intestine. Probiotics can also be taken as powders, gel caps, gummies, liquids, and foods such as yogurt. Delivery affects the dose that makes it to your intestine. Choose a delivery method that is easy and comfortable so you will be more likely to take probiotics regularly.

GI conditionStudied productsThird-party tested productsComments
ColicJarrow Formulas Baby's Jarro-Dophilus plus FOS Nature's Way Primadophilus Reuteri

Diarrhea after taking antibioticsAlignGarden of Life Raw Probiotics Ultimate CareBroad-spectrum (containing many different kinds) combination products likely to have the most benefit
Bio-K+Now Foods Probiotic-10
CulturelleRenew Life Ultimate Flora
DanActiveSedona Labs iFlora Multi-Probiotics
FlorastorConsider a minimum of 10 billion colony-forming units per day of each organism
HOWARU Restore
MIYAIRI 588
VSL#3

Diarrhea from Clostridium difficileAlignGarden of Life Raw Probiotics Ultimate Care
CulturelleNow Foods Probiotic-10
DanActiveRenew Life Ultimate Flora
FlorastorSedona Labs iFlora Multi-Probiotics
MIYAIRI 588
VSL#3

Helicobacter pylori infectionBacidGarden of Life Raw Probiotics Ultimate CareUsed with antibiotics
CulturelleNow Foods Probiotic-10
LactinexRenew Life Ultimate Flora
Sedona Labs iFlora Multi-Probiotics

Hepatic encephalopathyAlignGarden of Life Raw Probiotics Ultimate Care
MutaflorNow Foods Probiotic-10
VSL#3Renew Life Ultimate Flora
Sedona Labs iFlora Multi-Probiotics

Irritable bowel syndromeActiviaGarden of Life Raw Probiotics Ultimate Care
AlignNow Foods Probiotic-10
BacidRenew Life Ultimate Flora
CulturelleSedona Labs iFlora Multi-Probiotics
USANA
VSL#3
YoPlus

Necrotizing enterocolitisBacidFlorastor KidsProducts containing a variety of bifidobacteria species are most beneficial
CulturelleNature's Answer Probiotics for Kids
Florajen
Florastor

Ulcerative colitisActiviaGarden of Life Raw Probiotics Ultimate CareVSL#3 and similar high-dose multispecies products with several bifidobacteria species are preferred
AlignNow Foods Probiotic-10
BacidRenew Life Ultimate Flora
CulturelleSedona Labs iFlora Multi-Probiotics
Mutaflor
VSL#3

Where can I get more information?

Your doctor

AAFP's Patient Information Resource

Labdoor (probiotic product rankings)

National Institutes of Health: Dietary Supplement Label Database

National Institutes of Health: National Center for Complementary and Integrative Health

August 2017

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