3 Things to Remember When Taking a Probiotic

3 Things to Remember When Starting a Probiotic

Probiotics have been around for a while, but the jury is still out on whether or not they work. Whenever patients ask me whether they should take a probiotic, or they tell me that probiotics didn’t work for them, I remind them of three key points I learned while writing my book, Constipation Nation (probiotics is Chapter 11, “A Bug Up Your Gut”). Most of the time, this discussion leads to my patients giving probiotics another try. 

Probiotics are bacteria and fungi–microorganisms– that are good for your body. It’s important to note that some of these good microorganisms already live in your body– indeed, we are about 90% microorganisms (our microbiome)– and we want more good microorganisms and fewer bad ones, and the good ones have the ability to crowd the bad ones out. Such is the premise for how probiotics work. In the last decade, researchers have found that the microbiome affects not only digestive health, the obvious choice, but also mental health, heart health, and even your skin. So having a good microbiome is essential to good health. 

Now for the first thing to know: do probiotics have immediate effects on bowel movements? The answer, usually, is no. Probiotics are not a laxative medication and therefore do not have an instantaneous effect– that is, you take it and poop. Depending on your digestion, the effects may take a few hours or a few days. Probiotics have only been shown to affect the frequency of bowel movements, or how often you go. They don’t necessarily affect the consistency, ie, how hard or soft the stool is (fiber is a better option for consistency). Some people will report diarrhea with probiotics, which takes us to #2 (pun intended).

For every rule, there is an exception. Some people will go immediately or not at all after taking a probiotic. In those cases, there are two things to remember. The first is that you do need to take the right antibiotics. There are no regulatory guidelines in the USA to say what the ‘right’ antibiotics are, and there has been a recent trend towards producing ‘designer’ strains of combinations of probiotics. However, the research shows good results with two main classes: Bifidobacterium and Lactobacillus, specifically B. lactis and L. acidophilus, L. paracasei, and L. rhamnosus (with some newer research making a case for Bacillus species). So making sure your probiotic supplement has those strains is important. It should also be high-quality and from a reputable company that has done vigorous testing to make sure there are no contaminants in the supplement. Some of the fear of probiotics was from early supplements contaminated with disease-causing bacteria but that is much less of a problem these days. 

Lastly, if one particular brand of probiotics (or the specific set of strains) does not work for you, I suggest trying others before giving up completely. Just like our fingerprints and our DNA, all our microbiomes are different, and what works for one person may not work for another. I think, in the near future, we are going to find individual and regional differences in the microbiome. Some people may need more of one strain (for example, a lactase-digesting strain that may help with dairy intolerance) because they lost it as they got older or they moved to another country and it was crowded out. Just like eating a good variety of fruits and vegetables for all the assorted vitamins and minerals (“Eat the rainbow”), having a good mix of probiotics is going to be useful. That brings us to prebiotics… but that’s for another day. 

Please always make sure to check with a clinician before starting a probiotic regimen, as probiotics can be harmful in those with immune compromise, children, pregnant women, or those with short bowel syndrome.